title: Cardiovascular autonomic neuropathy is associated with macrovascular risk factors in type 2 diabetes: new technology used for routine large-scale screening adds new insight.
abstract: The objective was to identify the presence of cardiovascular autonomic neuropathy (CAN) in a cohort of individuals with diabetes in outpatient clinics from 4 different parts of Denmark and to explore the difference between type 1 and type 2 diabetes in relation to CAN. The DAN-Study is a Danish multicenter study focusing on diabetic autonomic neuropathy. Over a period of 12 months, 382 type 1 and 271 type 2 individuals with diabetes were tested for CAN. Patients were randomly recruited and tested during normal visits to outpatient clinics at 4 Danish hospitals. The presence of CAN was quantified by performing 3 cardiovascular reflex tests (response to standing, deep breathing, and valsalva). To describe possible associations, multivariate analysis with CAN as the dependent variable was performed. The prevalence of CAN was higher among patients with type 2 diabetes (35%) compared to patients with type 1 diabetes (25%). Multivariate analysis revealed significant associations between CAN and different risk markers in the 2 populations. In type 1 diabetes patients CAN was associated with microalbuminuria (P < .001), macroalbuminuria (P = .011), simplex retinopathy (P < .001), proliferative retinopathy (P < .001), and peripheral neuropathy (P = .041). Among type 2 diabetes patients CAN was independently associated with high pulse pressure (P < .01), BMI (P = .006), and smoking (P = .025). In this cross-sectional observational study CAN was independently associated with microvascular complication in type 1, whereas in type 2 CAN was associated with macrovascular risk factors.
authors.affiliation: Medical Research Laboratories, Clinical Institute of Medicine, Aarhus University and Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark Jesper.fleischer@ki.au.dk.
authors.forename: Jesper
authors.initials: J
authors.lastname: Fleischer
authors.affiliation: Department of Endocrinology, Odense University Hospital, Odense, Denmark.
authors.forename: Knud
authors.initials: K
authors.lastname: Yderstraede
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Gulichsen
authors.affiliation: Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Poul Erik
authors.initials: PE
authors.lastname: Jakobsen
authors.affiliation: Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Hans Henrik
authors.initials: HH
authors.lastname: Lervang
authors.affiliation: Department of Internal Medicine and Endocrinology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Ebbe
authors.initials: E
authors.lastname: Eldrup
authors.affiliation: Clinical Institute of Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: Nygaard
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark Clinical Institute of Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: Lise
authors.initials: L
authors.lastname: Tarnow
authors.affiliation: Medical Research Laboratories, Clinical Institute of Medicine, Aarhus University and Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Ejskjaer
mesh_terms: D000328:Adult; D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D002196:Capillaries / Q000473:pathology*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000473:pathology*; D002319:Cardiovascular System / Q000276:immunology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003718:Denmark / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003929:Diabetic Neuropathies / Q000473:pathology*; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D015995:Prevalence; D012307:Risk Factors
keywords: cardiac autonomic neuropathy; diabetes; hypertension; macrovascular complications; microvascular complications