Cardiovascular autonomic neuropathy, HDL-cholesterol, and smoking correlate with arterial stiffness markers determined 18 years later in type 1 diabetes

  1. Catherine T. Prince, PhD1,
  2. Aaron M. Secrest, MPH1,
  3. Rachel H. Mackey, PhD1,
  4. Vincent C. Arena, PhD2,
  5. Lawrence A. Kingsley, DrPH3 and
  6. Trevor J. Orchard, MD (orchardt{at}edc.pitt.edu)1
  1. 1Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
  2. 2Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
  3. 3Department of Infectious Disease and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania

Abstract

Objective: To examine the relationship between cardiovascular autonomic neuropathy (CAN) and pulse wave analysis (PWA) measures of arterial stiffness in a childhood onset type 1 diabetes population.

Research Design and Methods: Cardiac autonomic nerve function was measured in the baseline examination of the Pittsburgh EDC Study of childhood onset type 1 diabetes by heart rate variability (R-R interval) during deep breathing and expressed at expiration to inspiration (E/I ratio). Other cardiovascular and diabetes factors were also assessed. PWA was performed using SphgymoCor Px on 144 participants at the 18-year follow-up examination. Univariate and multivariate analyses for associations between baseline nerve function and other cardiovascular and diabetes related factors were performed for augmentation index (AIx), augmentation pressure (AP) and subendocardial viability ratio (SEVR), a surrogate marker of myocardial perfusion.

Results: E/I ratio correlated negatively with both AIx (r = −.18, p=.03) and AP (r=−.32, p<.001) and positively with SEVR (r =.47, p<.001), univariately. Lower baseline E/I ratio and HDL-cholesterol, and a history of smoking were associated with higher follow-up (18 years later) AIx and AP, and lower SEVR, in multivariate analyses. Higher baseline HbA1 was also associated with higher AP and lower SEVR multivariately.

Conclusions: CAN is associated with increased arterial stiffness measures and decreased estimated myocardial perfusion in type 1 diabetes some 18 years later. This association persists after adjustment for potential confounders as well as for baseline HbA1, HDL-c and smoking history, which were also associated with these PWA measures.

Footnotes

    • Received October 19, 2009.
    • Accepted December 19, 2009.

This Article

  1. Diabetes Care
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