Diabetic cardiovascular autonomic neuropathy: risk factors, clinical impact and early diagnosis.
Cardiovascular autonomic neuropathy (CAN) is one of the most clinically significant complications of diabetes mellitus (DM), but one of the least frequently diagnosed. In this review, we discuss the major risk factors for the development and progression of CAN in patients with DM, the natural history of autonomic neuropathy and its impact on cardiovascular disease in DM, as well as the tests for the early diagnosis and staging of CAN in the clinical practice. The bibliographic research was based on two databases: Medline and Tripdatabase, with the following descriptors: diabetic cardiovascular autonomic neuropathy and cardiovascular autonomic neuropathy and diabetes. We selected English and German articles, written between 1998 and 2007. In its initial stages (early and intermediate), CAN may be diagnosed and reversed. However, in advanced cases (severe stage), the only treatment that remains is a symptomatic one. CAN is associated with higher cardiovascular morbidity and mortality rates and poor quality of life in diabetic individuals.
Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, SP, Brasil. rolim777@gmail.com
Luiz Clemente de Souza Pereira
LC
Rolim
João Roberto de
JR
Sá
Antonio Roberto
AR
Chacra
Sérgio Atala
SA
Dib
D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D003943:Diagnostic Techniques, Neurological; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D012307:Risk Factors; D012720:Severity of Illness Index