Association between Brachial-Ankle pulse wave velocity and cardiac autonomic neuropathy in type 2 diabetes

Diabetology & Metabolic Syndrome

Renming Hu²  Weiwei Zhao²  Min He²  Yintao Li²  Kuanping Ye²  Xiaoling Cai¹  Nan Wu² 

[1] The Emergency Department, Zhongshan Hospital, Shanghai Medical College, Fudan University, 180 Fenglin Road, Shanghai, China;The Institute of Endocrinology and Diabetology, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China

关键词: Type 2 diabetes;    Brachial-ankle pulse wave velocity;    Cardiac autonomic neuropathy;   

Others  :  1115097
DOI  :  10.1186/1758-5996-6-82

 received in 2014-04-29, accepted in 2014-07-10,  发布年份 2014

【 摘 要 】

Background

Cardiac autonomic neuropathy (CAN) is a common complication of type 2 diabetes mellitus (T2DM). Brachial-ankle pulse wave velocity (baPWV) is known to be a good surrogate marker of vascular damages. The goal of this study was to investigate the relationship between BaPWV and CAN in T2DM.

Methods

A total of 148 patients who had no apparent history of cardiovascular condition were enrolled consecutively in this study. The correlation between increased baPWV and CAN was analyzed. CAN was evaluated by five standard cardiovascular reflex tests (CARTs) according to the Ewing's protocol: 1) heart rate variation during deep breathing, 2) heart rate response to standing, 3) Valsalva maneuver, 4) postural systolic blood pressure (BP) change, 5) Sustained handgrip test. CAN was defined as the presence of at least two abnormal tests.

Results

The mean age of patients was 59.8 ± 7.8 years. The mean duration of diabetes was 6.0(2.0-11.0) years. The mean baPWV was 1665.5(1482.0-1940.0) cm/sec. Subjects with CAN were older and had high BMI, baPWV compared with those without CAN. The proportion of patients with diabetic peripheral neuropathy was higher in subjects with CAN. After adjusting for other confounding risk factors, baPWV (odds ratio = 8.496, 95% CI: 1.216-59.348; P = 0.031) remained as independent risk factors for CAN. The number of abnormal CARTs increased gradually with increasing baPWV (correlation coefficient =0.255, p = 0.002).

Conclusion

Increased baPWV was significantly correlated with CAN in patients with type 2 diabetes.

【 授权许可】

   
2014 Wu et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Maser RE, Mitchell BD, Vinik AI, Freeman R: The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: a meta-analysis. Diabetes Care 2003, 26(6):1895-1901.
• [2]Kuehl M, Stevens MJ: Cardiovascular autonomic neuropathies as complications of diabetes mellitus. Nat Rev Endocrinol 2012, 8(7):405-416.
• [3]Vinik AI, Ziegler D: Diabetic cardiovascular autonomic neuropathy. Circulation 2007, 115(3):387-397.
• [4]van Popele NM, Grobbee DE, Bots ML, Asmar R, Topouchian J, Reneman RS, Hoeks AP, van der Kuip DA, Hofman A, Witteman JC: Association between arterial stiffness and atherosclerosis: the Rotterdam Study. Stroke 2001, 32(2):454-460.
• [5]Aso K, Miyata M, Kubo T, Hashiguchi H, Fukudome M, Fukushige E, Koriyama N, Nakazaki M, Minagoe S, Tei C: Brachial-ankle pulse wave velocity is useful for evaluation of complications in type 2 diabetic patients. Hypertens Res 2003, 26(10):807-813.
• [6]Yu WC, Chuang SY, Lin YP, Chen CH: Brachial-ankle vs carotid-femoral pulse wave velocity as a determinant of cardiovascular structure and function. J Hum Hypertens 2008, 22(1):24-31.
• [7]European Society of Hypertension-European Society of Cardiology Guidelines Committee: 2003 European society of hypertension-European society of cardiology guidelines for the management of arterial hypertension. J Hypertens 2003, 21(6):1011-1053.
• [8]Bagherzadeh A, Nejati-Afkham A, Tajallizade-Khoob Y, Shafiee A, Sharifi F, Esfahani MA, Badamchizade Z, Alatab S, Fakhrzadeh H: Association of cardiac autonomic neuropathy with arterial stiffness in type 2 diabetes mellitus patients. J Diab Metab Disord 2013, 12(1):55. BioMed Central Full Text
• [9]Ewing DJ, Martyn CN, Young RJ, Clarke BF: The value of cardiovascular autonomic function tests: 10 years experience in diabetes. Diabetes Care 1985, 8(5):491-498.
• [10]O'Brien IA, O'Hare JP, Lewin IG, Corrall RJ: The prevalence of autonomic neuropathy in insulin-dependent diabetes mellitus: a controlled study based on heart rate variability. Q J Med 1986, 61(234):957-967.
• [11]Ohnishi H, Saitoh S, Takagi S, Ohata J, Isobe T, Kikuchi Y, Takeuchi H, Shimamoto K: Pulse wave velocity as an indicator of atherosclerosis in impaired fasting glucose: the Tanno and Sobetsu study. Diabetes Care 2003, 26(2):437-440.
• [12]Scanlon PH, Foy C, Malhotra R, Aldington SJ: The influence of age, duration of diabetes, cataract, and pupil size on image quality in digital photographic retinal screening. Diabetes Care 2005, 28(10):2448-2453.
• [13]KDOQI work group: KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis 2007, 49(2 Suppl 2):S12-S154.
• [14]Tesfaye S, Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, Lauria G, Malik RA, Spallone V, Vinik A, Bernardi L, Valensi P, Toronto Diabetic Neuropathy Expert Group: Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care 2010, 33(10):2285-2293.
• [15]Jung CH, Baek AR, Kim KJ, Kim BY, Kim CH, Kang SK, Mok JO: Association between cardiac autonomic neuropathy, diabetic retinopathy and carotid atherosclerosis in patients with type 2 diabetes. Endocrinol Metab (Seoul) 2013, 28(4):309-319.
• [16]Sinha PK, Santr G, De D, Sah A, Biswas K, Bhattachary P, Ghosh P: Carotid intima-media thickness in type 2 diabetes mellitus patients with cardiac autonomic neuropathy. J Assoc Physicians India 2012, 60:14-18.
• [17]Krantz MJ, Long CS, Hosokawa P, Karimkahani E, Dickinson M, Estacio RO, Masoudi FA, Havranek EP: Pulse wave velocity and carotid atherosclerosis in white and Latino patients with hypertension. BMC Cardiovasc Disord 2011, 11:15. BioMed Central Full Text
• [18]Vlachopoulos C, Aznaouridis K, Stefanadis C: Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 2010, 55(13):1318-1327.
• [19]Yokoyama H, Shoji T, Kimoto E, Shinohara K, Tanaka S, Koyama H, Emoto M, Nishizawa Y: Pulse wave velocity in lower-limb arteries among diabetic patients with peripheral arterial disease. J Atheroscler Thromb 2003, 10(4):253-258.
• [20]Ha BK, Kim BG, Kim DH, Lee SI, Jung SM, Park JY, Lee CW, Kim SS, Kim BH, Kim IJ: Relationships between Brachial-Ankle Pulse Wave Velocity and Peripheral Neuropathy in Type 2 Diabetes. Diab Metab J 2012, 36(6):443-451.
• [21]Kubo T, Miyata M, Minagoe S, Setoyama S, Maruyama I, Tei C: A simple oscillometric technique for determining new indices of arterial distensibility. Hypertens Res 2002, 25(3):351-358.
• [22]Choi BG, Kang JH, Jeon YK, Kim SS, Lee CW, Kim IJ, Kim YK, Kim BH: Determinants of brachial-ankle pulse wave velocity in normotensive young adults with type 2 diabetes mellitus. J Korean Med Sci 2012, 27(11):1359-1363.
• [23]Meisinger C, Heier M, Landgraf R, Happich M, Wichmann HE, Piehlmeier W: Albuminuria, cardiovascular risk factors and disease management in subjects with type 2 diabetes: a cross sectional study. BMC Health Serv Res 2008, 8:226. BioMed Central Full Text
• [24]Jaiswal M, Urbina EM, Wadwa RP, Talton JW, D'Agostino RJ, Hamman RF, Fingerlin TE, Daniels S, Marcovina SM, Dolan LM, Dabelea D: Reduced heart rate variability among youth with type 1 diabetes: the SEARCH CVD study. Diabetes Care 2013, 36(1):157-162.
• [25]Pfeifer MA, Cook D, Brodsky J, Tice D, Reenan A, Swedine S, Halter JB, Porte DJ: Quantitative evaluation of cardiac parasympathetic activity in normal and diabetic man. Diabetes 1982, 31(4 Pt 1):339-345.
• [26]Vinik AI, Maser RE, Mitchell BD, Freeman R: Diabetic autonomic neuropathy. Diabetes Care 2003, 26(5):1553-1579.
• [27]Nemes A, Takacs R, Gavaller H, Varkonyi TT, Wittmann T, Forster T, Lengyel C: Correlations between aortic stiffness and parasympathetic autonomic function in healthy volunteers. Can J Physiol Pharmacol 2010, 88(12):1166-1171.
• [28]Frattola A, Parati G, Gamba P, Paleari F, Mauri G, Di Rienzo M, Castiglioni P, Mancia G: Time and frequency domain estimates of spontaneous baroreflex sensitivity provide early detection of autonomic dysfunction in diabetes mellitus. Diabetologia 1997, 40(12):1470-1475.
• [29]Mircoli L, Mangoni AA, Giannattasio C, Mancia G, Ferrari AU: Heart rate-dependent stiffening of large arteries in intact and sympathectomized rats. Hypertension 1999, 34(4 Pt 1):598-602.