title: Diabetic cardiac autonomic neuropathy, inflammation and cardiovascular disease.
abstract: One of the most overlooked of all serious complications of diabetes is cardiovascular autonomic neuropathy. There is now clear evidence that suggests activation of inflammatory cytokines in diabetic patients and that these correlate with abnormalities in sympathovagal balance. Dysfunction of the autonomic system predicts cardiovascular risk and sudden death in patients with type 2 diabetes. It also occurs in prediabetes, providing opportunities for early intervention. Simple tests that can be carried out at the bedside with real-time output of information - within the scope of the practicing physician - facilitate diagnosis and allow the application of sound strategies for management. The window of opportunity for aggressive control of all the traditional risk factors for cardiovascular events or sudden death with intensification of therapy is with short duration diabetes, the absence of cardiovascular disease and a history of severe hypoglycemic events. To this list we can now add autonomic dysfunction and neuropathy, which have become the most powerful predictors of risk for mortality. It seems prudent that practitioners should be encouraged to become familiar with this information and apply risk stratification in clinical practice. Several agents have become available for the correction of functional defects in the autonomic nervous system, and restoration of autonomic balance is now possible.
authors.affiliation: The Strelitz Diabetes Research Center and Neuroendocrine Unit, The Department of Medicine and Pathology/Anatomy/Neurobiology, Eastern Virginia Medical School Norfolk, Virginia, USA.
authors.forename: Aaron I
authors.initials: AI
authors.lastname: Vinik
authors.forename: Tomris
authors.initials: T
authors.lastname: Erbas
authors.forename: Carolina M
authors.initials: CM
authors.lastname: Casellini
keywords: Cardiac autonomic neuropathy; Inflammation; Pathogenesis
references.citation: Diabetes Res Clin Pract. 1996 Oct;34 Suppl:S165-71
references.pmid: 9015687
references.citation: JAMA. 2011 Dec 21;306(23):2579-87
references.pmid: 22187277
references.citation: Diabetes Care. 2009 Sep;32(9):1698-703
references.pmid: 19564456
references.citation: Circ J. 2004 Apr;68(4):343-7
references.pmid: 15056832
references.citation: Diabetes Metab Res Rev. 2011 Oct;27(7):654-64
references.pmid: 21695761
references.citation: Brain Behav Immun. 2008 May;22(4):461-8
references.pmid: 17977694
references.citation: J Clin Endocrinol Metab. 1986 Apr;62(4):658-63
references.pmid: 3081568
references.citation: JAMA. 2000 Jun 28;283(24):3223-9
references.pmid: 10866870
references.citation: Diabetes Care. 2010 Jul;33(7):1688-90
references.pmid: 20587730
references.citation: Diabetes Care. 2004 Aug;27(8):1954-61
references.pmid: 15277423
references.citation: Circulation. 2003 Feb 4;107(4):565-70
references.pmid: 12566367
references.citation: Diabetes Metab Res Rev. 2011 Oct;27(7):639-53
references.pmid: 21695768
references.citation: Diabet Med. 2011 Jun;28(6):643-51
references.pmid: 21569084
references.citation: J Intern Med. 2004 Jan;255(1):13-21
references.pmid: 14687234
references.citation: Neurology. 1995 Apr;45(4):773-80
references.pmid: 7723969
references.citation: Science. 1981 Jul 10;213(4504):220-2
references.pmid: 6166045
references.citation: Br Heart J. 1994 Jan;71(1):22-9
references.pmid: 8297687
references.citation: Diabetes Care. 2003 Jun;26(6):1895-901
references.pmid: 12766130
references.citation: Diabete Metab. 1993;19(1 Pt 2):143-51
references.pmid: 8314418
references.citation: Diabetes Care. 2011 Jul;34(7):1617-21
references.pmid: 21593297
references.citation: Clin Exp Hypertens. 2001 Jan-Feb;23(1-2):45-55
references.pmid: 11270588
references.citation: Diabetes Care. 2010 Jul;33(7):1578-84
references.pmid: 20215456
references.citation: Diabetes Care. 2004 Oct;27(10):2392-7
references.pmid: 15451906
references.citation: Diabetes Care. 2011 Apr;34(4):1060-3
references.pmid: 21447670
references.citation: Am J Cardiol. 2000 Aug 1;86(3):309-12
references.pmid: 10922439
references.citation: J Clin Invest. 2001 Oct;108(7):949-55
references.pmid: 11581294
references.citation: Diabetes Care. 1997 Mar;20(3):369-73
references.pmid: 9051389
references.citation: J Auton Nerv Syst. 1996 Apr 20;58(1-2):123-4
references.pmid: 8740670
references.citation: Circulation. 2007 Jan 23;115(3):387-97
references.pmid: 17242296
references.citation: Anesthesiology. 2000 May;92(5):1311-8
references.pmid: 10781276
references.citation: Med J Aust. 2006 Jan 16;184(2):60-3
references.pmid: 16411869
references.citation: J Intern Med. 1992 Jul;232(1):65-72
references.pmid: 1640194
references.citation: Cardiovasc Res. 2000 Mar;45(4):813-25
references.pmid: 10728407
references.citation: Am Heart J. 2003 Jul;146(1):115-20
references.pmid: 12851618
references.citation: Am J Physiol Regul Integr Comp Physiol. 2001 Apr;280(4):R929-34
references.pmid: 11247812
references.citation: Diabetes Care. 2003 May;26(5):1553-79
references.pmid: 12716821
references.citation: Diabetes. 2008 Apr;57(4):1002-17
references.pmid: 18039814
references.citation: Scand J Clin Lab Invest. 2008;68(7):654-9
references.pmid: 19378439
references.citation: Diabetes Care. 2008 Mar;31(3):556-61
references.pmid: 18086873
references.citation: Diabetes Care. 2010 Apr;33(4):721-7
references.pmid: 20103550
references.citation: Diabetes Care. 2010 Apr;33(4):748-50
references.pmid: 20097781
references.citation: Brain Res Bull. 1997;43(3):357-64
references.pmid: 9227848
references.citation: Neurosci Lett. 1995 Jan 2;183(1-2):27-31
references.pmid: 7746479
references.citation: Proc Natl Acad Sci U S A. 2009 Nov 24;106(47):20021-6
references.pmid: 19901339
references.citation: Diabetes Care. 2010 Oct;33(10):2285-93
references.pmid: 20876709
references.citation: Am J Cardiol. 1973 Jul;32(1):1-7
references.pmid: 4713110
references.citation: Curr Diab Rep. 2006 Dec;6(6):424-30
references.pmid: 17118224
references.citation: Diabetes Care. 2003 Jul;26(7):1955-60
references.pmid: 12832295
references.citation: Trends Immunol. 2003 Nov;24(11):574-9
references.pmid: 14596878
references.citation: Anesthesiology. 1989 Apr;70(4):591-7
references.pmid: 2929996
references.citation: Eur Heart J. 2004 Jul;25(14):1214-20
references.pmid: 15246639
references.citation: Brain. 1975 Sep;98(3):341-56
references.pmid: 810214
references.citation: J Nucl Cardiol. 2011 Oct;18(5):959-65
references.pmid: 21785921
references.citation: N Engl J Med. 2008 Feb 7;358(6):580-91
references.pmid: 18256393
references.citation: Diabetologia. 2005 Aug;48(8):1637-44
references.pmid: 16021416
references.citation: Cell. 2012 Feb 3;148(3):392-4
references.pmid: 22304908
references.citation: Exp Diabetes Res. 2012;2012:878760
references.pmid: 22110481
references.citation: Diabet Med. 2002 Nov;19(11):900-9
references.pmid: 12421426
references.citation: J Clin Endocrinol Metab. 2007 Oct;92(10):3885-9
references.pmid: 17666483
references.citation: Diabetologia. 1998 Apr;41(4):416-23
references.pmid: 9562345
references.citation: Nat Rev Immunol. 2009 Jun;9(6):418-28
references.pmid: 19461672
references.citation: Nature. 2000 May 25;405(6785):458-62
references.pmid: 10839541
references.citation: Lancet. 1999 Feb 20;353(9153):617-22
references.pmid: 10030326
references.citation: Arterioscler Thromb Vasc Biol. 1999 Aug;19(8):1979-85
references.pmid: 10446081
references.citation: J Intern Med. 2009 Apr;265(4):439-47
references.pmid: 19019182