Cardiovascular autonomic neuropathy associated with carotid atherosclerosis in Type 2 diabetic patients.
OBJECTIVE
To clarify if cardiovascular autonomic neuropathy is associated with carotid artery atherosclerotic plaques in Type 2 diabetic patients.


METHODS
Cardiovascular autonomic nerve function was related to carotid artery ultrasound in 61 Type 2 diabetic patients 5-6 years after diagnosis of diabetes.


RESULTS
Cardiovascular autonomic neuropathy [abnormal age corrected expiration/inspiration (E/I) ratio or acceleration index (AI)] was found in 13/61 (21%) patients. Patients with cardiovascular autonomic neuropathy showed increased degree of stenosis in the common carotid artery (24.6 +/- 13.2% vs. 14.7 +/- 9.2%; P = 0.014) and a tendency towards a higher plaque score (4.0 +/- 1.7 vs. 3.2 +/- 1.6; P = 0.064). Controlled for age, AI correlated inversely with degree of stenosis (r = -0.39; P = 0.005), plaque score (r = -0.39; P = 0.005), and mean (r = -0.33; P = 0.018) and maximum (r = -0.39; P = 0.004) intima-media thickness in the common carotid artery. In contrast, E/I ratio correlated only slightly with mean intima-media thickness in the common carotid artery (r = -0.28; P = 0.049).


CONCLUSIONS
Cardiovascular autonomic neuropathy was associated with carotid atherosclerosis in Type 2 diabetic patients. Abnormal E/I ratios reflect efferent structural damage to parasympathetic nerves whereas abnormal AI reflects afferent autonomic dysfunction possibly due to impaired baroreceptor sensitivity secondary to carotid atherosclerosis.
Gottsäter
A
A
Department of Vascular Diseases, University of Lund, University Hospital, Malmö, Sweden. gottsater@skane.se
Rydén-Ahlgren
A
A
Szelag
B
B
Hedblad
B
B
Persson
J
J
Berglund
G
G
Wroblewski
M
M
Sundkvist
G
G
D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000000981:diagnostic imaging; D003925:Diabetic Angiopathies / Q000150:complications* / Q000000981:diagnostic imaging; D003929:Diabetic Neuropathies / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography