Predictors of cardiovascular autonomic neuropathy onset and progression in a cohort of type 1 diabetic patients

• Autores: Matta, M.; Pavy Le Traon, Anne; Pérez Lloret, Santiago; Laporte, C.; Berdugo, I.; Nasr, N.; Hanaire, H.; Senard, J. M.
• Año de publicación: 2018
• Idioma: inglés
• Tipo de recurso: artículo
• Materia: autonomic neuropathy; diabetes; progression; predictors
• Institución: Consejo Nacional de Investigaciones Científicas y Técnicas

Aim. The prevalence of cardiovascular autonomic neuropathy (CAN) in diabetes mellitus is well documented. However, the rate and predictors of both the development and progression of CAN have been less studied. Hereby, we assessed the rate and the major risk factors for CAN initiation and progression in a cohort of type 1 diabetic patients followed over a three-year period. Methods. 175 type 1 diabetic patients (mean age: 50 ± 11 years; female/male: 76/99) with positive bedside screening for CAN were included and underwent 2 standardized autonomic testings using 4 standardized tests (deep breathing, Valsalva maneuver, 30/15 ratio, and changes in blood pressure during standing), separated by 3 ± 1 years. CAN staging was achieved according to the Toronto Consensus Panel on Diabetic Autonomic Neuropathy into 4 categories: absent, possible, confirmed, or severe CAN. Results. Out of the 175 patients included, 31.4% were free of CAN, 34.2% had possible CAN, 24.6% had confirmed CAN, and 9.7% exhibited severe CAN at the first assessment. Among the 103 patients with nonsevere CAN at inclusion, forty-one (39.8%) had an increase of at least one category when reassessed and 62 (60.2%) remained stable. A bivariate analysis indicated that only BMI and exposure to selective serotonin reuptake inhibitors (SSRIs) were significantly different in both groups. A multivariate analysis indicated that lower BMI (OR: 0.15, CI 95%: 0.05-0.48, p = 0 003) and SSRI exposure (OR: 4.18, CI 95%: 1.03-16.97, p = 0 04) were the sole predictors of CAN deterioration. In the 55 patients negative for CAN at the first laboratory assessment, 12 became positive at the second assessment. Conclusion. No clear predictive factor for CAN onset was identified. However, once present, CAN progression was related to low BMI and SSRI exposure.
Fil: Matta, M.. Centre Hospitalier Universitaire de Toulouse; Francia
Fil: Pavy Le Traon, Anne. Institut des Maladies Métaboliques et Cardiovasculaires; Francia. Hôpital Pierre-Paul Riquet; Francia
Fil: Pérez Lloret, Santiago. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas; Argentina
Fil: Laporte, C.. Centre Hospitalier Universitaire de Toulouse; Francia
Fil: Berdugo, I.. Centre Hospitalier Universitaire de Toulouse; Francia
Fil: Nasr, N.. Hôpital Pierre-Paul Riquet; Francia. Institut des Maladies Métaboliques et Cardiovasculaires; Francia
Fil: Hanaire, H.. Centre Hospitalier Universitaire de Toulouse; Francia
Fil: Senard, J. M.. Centre Hospitalier Universitaire de Toulouse; Francia. Institut des Maladies Métaboliques et Cardiovasculaires; Francia