Changing associations between progressive cardiovascular autonomic neuropathy and carotid atherosclerosis with increasing duration of type 2 diabetes mellitus.
To clarify associations between cardiovascular autonomic neuropathy (CAN) and the progression of carotid artery atherosclerosis in Type 2 diabetic patients, cardiovascular autonomic nerve function was related to carotid artery ultrasound in 61 Type 2 diabetic patients, 5 and 8 years after the diagnosis of diabetes. Between 5 and 8 years after diagnosis, age-adjusted acceleration index (AI) decreased (from -0.306+/-1.034 to -0.702+/-1.072; P=.0139), whereas age-adjusted expiration/inspiration (E/I) ratio was unchanged (-0.583+/-1.038 and -0.828+/-1.028; P=.1164). Intima-media thickness (IMT) increased in both the common carotid artery (CCA; from 0.854+/-0.219 to 0.913+/-0.241 mm; P<.0001) and the carotid bulb (from 1.789+/-0.714 to 2.128+/-0.881 mm; P<.0001), corresponding to a yearly IMT increase of 0.032+/-0.039 mm in the CCA and 0.146+/-0.204 mm in the carotid bulb. This value did not correlate with the AI or E/I ratios. In age-controlled partial correlation in the first examination, AI correlated inversely with mean (r=-.33, P=.018) IMT in the CCA, but not with IMT in the carotid bulb (r=-.14, P=.303). However, in contrast to the first examination, at follow-up, AI correlated inversely with the mean IMT of the carotid bulb (r=-.40, P=.007), lumen diameter of the CCA (r=-.31, P=.034), and plaque score (r=-.29, P=.041), but not with IMT of the CCA (r=-.04, P=.861). There were no correlations between the E/I ratio and carotid variables. In conclusion, CAN was associated with features of carotid atherosclerosis, which, in the carotid bulb, might affect baroreceptor function with the progression of Type 2 diabetes.
Department of Vascular Diseases, University Hospital, University of Lund, S-205 02 Malmö, Sweden. anders.gottsater@skane.se
Anders
A
Gottsäter
Beata
B
Szelag
Göran
G
Berglund
Marek
M
Wroblewski
Göran
G
Sundkvist
D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000209:etiology*; D002319:Cardiovascular System / Q000294:innervation*; D002340:Carotid Artery Diseases / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis; D003925:Diabetic Angiopathies / Q000150:complications*; D003929:Diabetic Neuropathies / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D017539:Tunica Intima / Q000473:pathology*