Cardiac autonomic neuropathy in relation to some components of metabolic syndrome in newly diagnosed type 2 diabetic patients
MA Nishnianidze, RB Kurashvili, MG Khelashvili, LR Tsutskiridze & MG Bekaia
Background and Aims: Components of metabolic syndrome (MS) carry an increased risk for cardiovascular disease (CVD). People with abnormal glucose regulation are more prone to develop complications. At diagnosis 20-30% of type 2 diabetic (T2DM) patients (pts) already have neuropathy-one of the most dangerous complications. Cardiac autonomic neuropathy (CAN) is associated with five-fold risk of mortality. Our aim was to study possible relation between CAN and some components of MS in newly diagnosed T2DM pts.
Materials and Methods: We observed 33 T2DM pts with Grade 1/2 arterial hypertension (AH) (ESH/ESC Guidelines), increased BMI, but without known CVD, ketoacidosis, alcoholism and/or liver disease. males/females-21/12, mean age-47.5±4.8 yrs.; mean HbA1c-8.1±2.04%; mean BMI-29.6±3.3 kg/m2). Ewings standard reflex tests were performed; severity of CAN was evaluated according to Jermendy et al., 1995. Lipid profile, resting blood pressure (BP), pulse pressure (PP) and heart rate (HR) were assessed.
Results: Response CAN reflex tests were normal in 15 cases (45.4%); 13 pts (39.4%) had mild, and 5 (15.1%) moderate CAN. No severe CAN was registered. There was positive correlation between prevalence of CAN and HbA1c (P<0.001); CAN and mean heart rate (P<0.001), CAN and mean SBP/PP (P<0.05). Only 7 pts had normal lipid profile. High total cholesterol levels (mean 5.59±0.84 mmol/l) were registered in 18 cases, elevated LDL levels (mean 3.86±1.10 mmol/l)-in 4 pts; low HDL levels (mean 0.89±0.69 mmol/l)-in 21 pts; high triglycerides (mean 2.91±0.54 mmol/l)-in 8 pts. No statistically evident correlation was observed between CAN severity and lipid profile indices.
Conclusion: CAN was registered in 54.5% of patients; compared to general population abnormal lipid profile indices were observed more frequently (78.9%) in the study population. We can presume, that in newly diagnosed T2DM hyperglycemia, that may be asymptomatic and not treated for years, plays more important role in CAN development than lipid disorders.