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Diabetic Cardiac Autonomic Neuropathy

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Abstract

Cardiac autonomic neuropathy (CAN) is a serious and common complication of diabetes mellitus (DM). Despite its relationship to an increased risk of cardiovascular mortality and its association with multiple symptoms and impairments, the significance of CAN has not been fully appreciated. This chapter contains the review of the latest evidence and own data regarding the epidemiology, pathogenesis, clinical signs, diagnosis of CAN; treatment and the treatment perspectives for diabetic CAN. Lifestyle modification, intensive glycemic control might prevent development or progression of CAN. Pathogenetic treatment of CAN includes: optimization of glycemic control; balanced diet and physical activity; treatment of dyslipoproteinemia; correction of metabolic abnormalities in myocardium; prevention and treatment of thrombosis; use of aldose reductase inhibitors; angiotensin-converting enzyme inhibitors, prostaglandin analogs, acetyl-L-carnitine, antioxidants, first of all α-lipoic acid, use of ω-3 polyunsaturated fatty acids, vasodilators, fat-soluble vitamin B1, aminoguanidine; substitutive therapy of growth factors, in severe cases-, treatment of orthostatic hypotension.

The following chapter includes the epidemiology, pathogenesis, clinical impact, assessment, diagnosis and staging, diagnostic criteria, and approaches to prevention and treatment of CAN.

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Abbreviations

ABPM:

Ambulatory blood pressure monitoring

BP:

Blood pressure

BRS:

Baroreflex sensitivity

CAD:

Coronary artery disease

CAN:

Cardiac autonomic neuropathy

CARTs:

Cardiovascular autonomic reflex tests

CHD:

Coronary heart disease

CVD:

Cardiovascular diseases

DLP:

Dyslipidemia

DM:

Diabetes mellitus

GLP1-RA:

Glucagon-like peptide 1 receptor agonists

HR:

Heart rate

HRT:

Heart rate turbulence

HRV:

Heart rate variability

LV:

Left ventricular

MI:

Myocardial infarction

MSNA :

Muscle sympathetic nerve activity

OH:

Orthostatic hypotension

QTi:

QT interval

SGLT2i:

Sodium glucose transporter 2 inhibitors

SMI:

Silent myocardial ischemia

T1DM:

Type 1 diabetes mellitus

T2DM:

Type 2 diabetes mellitus

α-LA:

α-Lipoic acid

ω-3 PUFA:

ω-3 Polyunsaturated fatty acids

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Authors and Affiliations

  1. Department of Endocrinology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine

    Victoria Serhiyenko & Alexandr Serhiyenko

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  1. Victoria Serhiyenko
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Editors and Affiliations

  1. Mexico City, Mexico

    Joel Rodriguez-Saldana

Glossary

Cardiac autonomic neuropathy

Cardiac autonomic neuropathy chronic complication of diabetes mellitus is defined as the impairment of autonomic control of the cardiovascular system in the setting of diabetes after exclusion of other causes and is usually documented by using several cardiovascular autonomic reflex tests.

Cardiovascular autonomic reflex tests

Cardiovascular autonomic reflex tests these tests are considered the gold standard in autonomic testing. Heart rate variations during deep breathing, Valsalva maneuver, and lying-to-standing (HR tests) are indices mainly of parasympathetic function; whereas the orthostatic hypotension, the blood pressure response to a Valsalva maneuver, and sustained isometric muscular strain provide indices of sympathetic function.

Orthostatic hypotension

Orthostatic hypotension is defined as a fall in BP (i.e., >20 mmHg or more stringent criteria is >30 mmHg for systolic or >10 mmHg for diastolic BP) in response to postural change, from supine to standing.

Non-dipping status

Non-dipping status a fall in average sleeping blood pressure <10% from baseline.

Reverse dipping

Reverse dipping nocturnal hypertension.

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Serhiyenko, V., Serhiyenko, A. (2023). Diabetic Cardiac Autonomic Neuropathy. In: Rodriguez-Saldana, J. (eds) The Diabetes Textbook. Springer, Cham. https://doi.org/10.1007/978-3-031-25519-9_57

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