KMID : 0356620130280040309
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Journal of Korean Society of Endocrinology 2013 Volume.28 No. 4 p.309 ~ p.319
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Association between Cardiac Autonomic Neuropathy, Diabetic Retinopathy and Carotid Atherosclerosis in Patients with Type 2 Diabetes
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Jung Chan-Hee
Baek Ae-Rin Kim Kyu-Jin Kim Bo-Yeon Kim Chul-Hee Kang Sung-Koo Mok Ji-Oh
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Abstract
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Background: It is not clear whether microangiopathies are associated with subclinical atherosclerosis in type 2 diabetes mellitus (T2DM). We investigated the relation of cardiac autonomic neuropathy (CAN) and other microangiopathies with carotid atherosclerosis in T2DM.
Methods: A total of 131 patients with T2DM were stratified by mean carotid intima-media thickness (CIMT) ¡Ã or <1.0 mm and the number of carotid plaques. CAN was assessed by the five standard cardiovascular reflex tests according to the Ewing¡¯s protocol. CAN was defined as the presence of at least two abnormal tests or an autonomic neuropathy points ¡Ã2. Diabetic microangiopathies were assessed.
Results: Patients with CAN comprised 77% of the group with mean CIMT ¡Ã1.0 mm, while they were 29% of the group with CIMT <1.0 mm (P=0.016). Patients with diabetic retinopathy (DR) comprised 68% of the group with CIMT ¡Ã1.0 mm, while they were 28% of the group without CIMT thickening (P=0.003). Patients with CAN comprised 51% of the group with ¡Ã2 carotid plaques, while they were 23% of the group with ¡Â1 carotid plaque (P=0.014). In multivariable adjusted logistic regression analysis, the patients who presented with CAN showed an odds ratio [OR] of 8.6 (95% confidence interval [CI], 1.6 to 44.8) for CIMT thickening and an OR of 2.9 (95% CI, 1.1 to 7.5) for carotid plaques. Furthermore, patients with DR were 3.8 times (95% CI, 1.4 to 10.2) more likely to have CIMT thickening.
Conclusion: These results suggest that CAN is associated with carotid atherosclerosis, represented as CIMT and plaques, independent of the traditional cardiovascular risk factors in T2DM. CAN or DR may be a determinant of subclinical atherosclerosis in T2DM.
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KEYWORD
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Cardiac autonomic neuropathy, Diabetic angiopathies, Carotid intima-media thickness, Carotid plaque, Diabetes mellitus, type 2
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