Photo Credit: Mohammed Haneefa Nizamudeen
The following is a summary of the “Prevalence and prognostic significance of cardiac autonomic neuropathy in community-based people with type 2 diabetes: the Fremantle Diabetes Study Phase II,” published in the March 2024 issue of Cardiology by Davis et al.
In this study, researchers aimed to address the gap in contemporary data regarding the prevalence and prognostic implications of cardiac autonomic neuropathy (CAN) among community-based individuals with type 2 diabetes, utilizing gold-standard assessment methods. The longitudinal observational Fremantle Diabetes Study Phase II (FDS2) served as the platform for this investigation. Screening FDS2 participants at baseline involved standardized cardiovascular reflex tests (CARTs) to evaluate heart rate variation during deep breathing, Valsalva maneuver, and standing. The CAN status (no/possible/definite) was determined based on the number of abnormal CARTs.
Multinomial regression analyses were employed to identify independent associates of CAN status. Cox proportional hazard modeling was utilized to ascertain independent baseline predictors of incident heart failure (HF), ischemic heart disease (IHD), and all-cause mortality. Among the 1254 participants assessed for CAN, a subset was excluded due to age reference range discrepancies or unavailable valid CART data, leaving 830 individuals for analysis. Notably, a substantial proportion of participants demonstrated some level of CAN, with definite CAN being independently associated with several factors, including longer diabetes duration, higher body mass index, and prior HF.
Kaplan–Meier analysis revealed a graded increase in all-cause mortality risk corresponding to the severity of CAN. While CAN status was not found to be a significant independent predictor of IHD or HF when added to the most economical models, both possible and definite, CAN was associated with an increased risk of all-cause mortality compared to no CAN. These findings underscore the potential prognostic value of routine CAN screening in type 2 diabetes, although its clinical utility may be somewhat limited.
Source: cardiab.biomedcentral.com/articles/10.1186/s12933-024-02185-3