title: Cardiovascular autonomic neuropathy and subclinical cardiovascular disease in normoalbuminuric type 1 diabetic patients.
abstract: Cardiovascular autonomic neuropathy (CAN) is associated with increased mortality in diabetes. Since CAN often develops in parallel with diabetic nephropathy as a confounder, we aimed to investigate the isolated impact of CAN on cardiovascular disease in normoalbuminuric patients. Fifty-six normoalbuminuric, type 1 diabetic patients were divided into 26 with (+) and 30 without (-) CAN according to tests of their autonomic nerve function. Coronary artery plaque burden and coronary artery calcium score (CACS) were evaluated using computed tomography. Left ventricular function was evaluated using echocardiography. Blood pressure and electrocardiography were recorded through 24 h to evaluate nocturnal drop in blood pressure (dipping) and pulse pressure. In patients +CAN compared with -CAN, the CACS was higher, and only patients +CAN had a CACS >400. A trend toward a higher prevalence of coronary plaques and flow-limiting stenosis in patients +CAN was nonsignificant. In patients +CAN, left ventricular function was decreased in both diastole and systole, nondipping was more prevalent, and pulse pressure was increased compared with -CAN. In multivariable analysis, CAN was independently associated with increased CACS, subclinical left ventricular dysfunction, and increased pulse pressure. In conclusion, CAN in normoalbuminuric type 1 diabetic patients is associated with distinct signs of subclinical cardiovascular disease.
authors.affiliation: The Heart Centre, Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark. ulrik_mogensen@hotmail.com
authors.forename: Ulrik Madvig
authors.initials: UM
authors.lastname: Mogensen
authors.forename: Tonny
authors.initials: T
authors.lastname: Jensen
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.forename: Anne Sophie
authors.initials: AS
authors.lastname: Mathiesen
authors.forename: Ulrik
authors.initials: U
authors.lastname: Dixen
authors.forename: Peter
authors.initials: P
authors.lastname: Rossing
authors.forename: Jannik
authors.initials: J
authors.lastname: Hilsted
authors.forename: Klaus Fuglsang
authors.initials: KF
authors.lastname: Kofoed
mesh_terms: D000328:Adult; D000368:Aged; D001341:Autonomic Nervous System / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002319:Cardiovascular System / Q000000981:diagnostic imaging / Q000294:innervation / Q000503:physiopathology*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human