Association of Cardiovascular Autonomic Dysfunction With Peripheral Arterial Stiffness in Patients With Type 1 Diabetes
Association of Cardiovascular Autonomic Dysfunction With Peripheral Arterial Stiffness in Patients With Type 1 Diabetes
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DOI：
10.1210/jc.2018-02729
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发表时间：
2019-07-01
影响因子：
5.8
通讯作者：
Luque-Ramirez, Manuel
中科院分区：
文献类型：
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作者：
Nattero-Chavez, Lia;Redondo Lopez, Sandra;Luque-Ramirez, Manuel
背景：心血管自主神经病变（CAN）似乎有助于1型糖尿病的外周动脉僵硬（AS）。AS患者的CAN是否与伴发无症状外周动脉疾病（aPAD）相关尚不清楚。目的：评价1型糖尿病合并AS患者发生CAN的风险及其与动脉粥样硬化的潜在关系。设计：横断面研究。环境：一所学术医院的1型糖尿病门诊。患者：264例1型糖尿病患者。干预：AS定义为踝-肱指数（ABI） bbb1.2， aPAD定义为趾-肱指数和多普勒超声，CAN定义为血压和心率对活动站立和Ewing和Clarke试验的反应。主要观察指标：AS患者发生CAN的几率。CAN的几率也被计算为as和伴发aPAD存在的函数。结果：研究人群平均年龄35.6 11岁，病程19.6 10年，平均糖化血红蛋白为7.5% +/- 1.3%。73例（28%）为外周AS，其中28例为aPAD。AS患者的CAN患病率为48%，而ABI正常的受试者只有23% （OR: 3.1[1.7; 5.4]）。伴随aPAD增加CAN的OR （OR: 4.5[2.0; 10.1]）。在调整aPAD和相关心血管危险因素后，AS仍与副交感神经功能障碍相关。结论：在1型糖尿病中，外周AS和动脉粥样硬化均与CAN相关。一种简单的方法，如ABI，可以识别出一部分未确诊的自主神经异常患者。
Context: Cardiovascular autonomic neuropathy (CAN) appears to contribute to peripheral arterial stiffness (AS) in type 1 diabetes. Whether CAN in patients with AS is associated with concomitant asymptomatic peripheral arterial disease (aPAD) remains unclear.Objective: To assess the risk of CAN in patients with type 1 diabetes and AS and its potential association with atherosclerosis.Design: Cross-sectional study.Setting: Type 1 diabetes clinic in an academic hospital.Patients: Two hundred sixty-four patients with type 1 diabetes.Intervention: AS was defined as an ankle-brachial index (ABI)>1.2, aPAD by the toe-brachial index and Doppler sonography, and CAN by blood pressure and heart rate responses to active standing and Ewing and Clarke tests.Main Outcome Measures: Odds of having CAN among patients with AS. Odds for CAN were also calculated as a function of the presence of AS and concomitant aPAD.Results: The study population's mean age was 35 6 11 years, with a duration of disease of 19 6 10 years and mean hemoglobin A1c of 7.5% +/- 1.3%. Seventy-three patients (28%) had peripheral AS, of whom 28 showed aPAD. The prevalence of CAN among patients with AS was 48% but it was only 23% in subjects with normal ABI (OR: 3.1 [1.7; 5.4]). Concomitant aPAD increased the OR for CAN (OR: 4.5 [2.0; 10.1]). After adjustments for aPAD and relevant cardiovascular risk factors, AS remained associated with parasympathetic dysfunction.Conclusions: In type 1 diabetes, both peripheral AS and atherosclerosis were associated with CAN. A simple method, such as the ABI, may identify a subset of patients with undiagnosed dysautonomia.