Cardiovascular autonomic neuropathy (expiration and inspiration ratio) in type 1 diabetes. Incidence and predictors.
The pathogenesis of diabetic neuropathy is poorly understood. In this prospective study, we investigated the incidence rate and potential predictors for cardiovascular autonomic neuropathy (CAN) in a cohort of childhood-onset type 1 diabetic patients. Subjects from the Epidemiology of Diabetes Complications Study were examined at baseline and then biennially. CAN was diagnosed by abnormal (</=1. 1) expiration/inspiration ratio during deep breathing. During the 4. 7-year mean follow-up period, CAN developed in 104 patients from the 373 subjects who were free of CAN at baseline and provided follow-up data, an incidence-density of 5.9 cases/100 person-years. Cox proportional hazard modeling showed age (relative risk [RR]=2.15, p=0.0001), HbA1 (RR=1.50, p=0.0002) and nephropathy (albumin excretion >200 ug/min) (RR=2.46, p=0.0001) to be significant independent predictors. Hypertension was, however, predictive if nephropathy was not included in the model. We conclude that beyond age and poor glycemic control, nephropathy is a significant risk factor for CAN and this association may explain some of the increased mortality seen in CAN.
Stella
P
P
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, DLR Building, 3512 Fifth Avenue, Pittsburgh, PA 15213, USA.
Ellis
D
D
Maser
R E
RE
Orchard
T J
TJ
D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D001794:Blood Pressure; D008078:Cholesterol, LDL / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006442:Glycated Hemoglobin / Q000032:analysis; D006321:Heart / Q000294:innervation*; D006801:Humans; D008297:Male; D014280:Triglycerides / Q000097:blood
D008078:Cholesterol, LDL; D005340:Fibrinogen; D006442:Glycated Hemoglobin; D014280:Triglycerides