Impaired cardiovagal activity as a link between hyperglycemia and arterial stiffness in type-2 diabetes mellitus patients among Eastern Indian population: A cross-sectional study.

Abstract

Introduction

Cardiac autonomic neuropathy (CAN) is one of the most common yet overlooked complications in Type- 2 Diabetes mellitus (T2DM). The T2DM patients with CAN show a fivefold increase in Cardiovascular morbidity and mortality. The presence of CAN in T2DM could potentially lead to arterial stiffness. However, there is sparse data available to prove this association between autonomic dysfunction and arterial stiffness in T2DM.

Methods

We recruited 80 T2DM patients and 74 healthy controls. Heart rate variability (HRV) was done to assess autonomic function. The assessment of arterial stiffness was done by measuring brachial Pulse wave velocity (baPWV) and Augmentation index (AI).

Results

The time domain parameters were significantly decreased (P<0.001) and frequency domain parameters like total power and HFnu were found to be significantly reduced in T2DM patients (P<0.001). The baPWV and AI were significantly higher in T2DM compared to healthy controls (P<0.001). We observed a moderate correlation between SDNN and baPWV (r= -0.437, P 0.002) and AI (r= -0.403, P 0.002). The multiple linear regression model shows an association between SDNN and arterial stiffness parameters like baPWV and AI which was statistically significant (p<0.05) in the fully adjusted model which includes the conventional risk factors for atherosclerosis.

Conclusion

The impaired cardiovagal activity is an independent risk factor for the development of arterial stiffness. Incorporation of HRV test into diabetes management protocol will have potential benefits of identifying the patients at high risk of developing cardiovascular events. Hence, preventive measures can be taken at the earliest to improve patient outcomes.