Cardiovascular autonomic dysfunction predicts acute ischaemic stroke in patients with Type 2 diabetes mellitus: a 7-year follow-up study.
OBJECTIVE
We investigated whether cardiovascular autonomic neuropathy (CAN) is associated with acute ischaemic stroke in patients with Type 2 diabetes.


METHODS
From 1999 to 2000, cardiovascular autonomic function tests were conducted in patients with Type 2 diabetes (n = 1458). Patients were followed up between 2006 and 2007. Standard tests for CAN measured heart rate variability parameters [expiration-to-inspiration (E/I) ratio, responses to the Valsalva manoeuvre and standing]. Using the American Diabetes Association criteria, the CAN scores were determined from the results of each test as follows: 0 = normal, 1 = abnormal (total maximum score 3). We assessed the development of acute ischaemic stroke events.


RESULTS
The prevalence of CAN at baseline was 55.7% (E/I 17.1%, Valsalva 39.4%, posture 27.3%) (n = 1126). During follow-up, 131 patients (11.6%) developed acute ischaemic stroke. The vascular events were more frequent in older patients (P < 0.001) and in those with diabetes of longer duration (P = 0.022), hypertension (P < 0.001) or diabetic retinopathy (P = 0.03) than in patients without vascular events. Patients with ischaemic stroke had higher creatinine levels (P = 0.045) and higher urine albumin excretion (P = 0.025) than those of patients without stroke. Cox proportional hazard regression analysis revealed that the CAN score was associated with the development of acute ischaemic stroke (total score 0 vs. 3, adjusted hazard ratio 2.7, 95% CI 1.3-5.5, P = 0.006).


CONCLUSIONS
Cardiovascular autonomic dysfunction was significantly associated with the development of ischaemic stroke in patients with Type 2 diabetes.
Ko
S H
SH
Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea.
Song
K H
KH
Park
S A
SA
Kim
S R
SR
Cha
B Y
BY
Son
H Y
HY
Moon
K W
KW
Yoo
K D
KD
Park
Y M
YM
Cho
J H
JH
Yoon
K H
KH
Ahn
Y B
YB
D000367:Age Factors; D000368:Aged; D000419:Albuminuria / Q000150:complications; D001341:Autonomic Nervous System / Q000503:physiopathology*; D015415:Biomarkers / Q000652:urine; D002319:Cardiovascular System / Q000503:physiopathology*; D003404:Creatinine / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology / Q000652:urine; D003930:Diabetic Retinopathy / Q000503:physiopathology / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000652:urine; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011187:Posture; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D020521:Stroke / Q000150:complications* / Q000503:physiopathology / Q000652:urine; D013997:Time Factors; D014636:Valsalva Maneuver
D015415:Biomarkers; D003404:Creatinine