The role of cardiovascular autonomic neuropathy in the development of cardiorenal complications in patients with type 2 diabetes mellitus

Introduction. Among the most significant complications of diabetes mellitus (DM) is cardiovascular autonomic neuropathy (CAN) that is a serious but sometimes poorly recognised complication.

Аim. To evaluate the prevalence of cardiovascular autonomic neuropathy (CAN) and its role in the development of chronic heart failure (CHF), chronic kidney disease (CKD) and atherosclerotic cardiovascular diseases (ACCD) in patients with type 2 diabetes mellitus (T2DM).

Materials and methods. 80 patients with DM2 were examined. To diagnose CAN, each patient underwent a set of functional tests (Table 1), the patients were divided into 2 groups: with a confirmed diagnosis of CAN and without CAN. Clinical and anamnestic, laboratory data and a set of instrumental studies for the diagnosis of cardiorenal complications of diabetes were evaluated. A comparison of the prevalence, as well as the risk ratio for the main complications of type 2 diabetes has been carried out.

Results. In the CAN group, heart failure (HF) was diagnosed significantly more frequently, occurring in 87.9% of cases compared to 59.5% in the group without CAN (p < 0.05). It was established that CAN correlates primarily with the development of heart failure with preserved ejection fraction (HFpEF): 78.8% vs. 34.0% (p < 0.05). Differences in the prevalence of chronic kidney disease and atrial fibrillation showed borderline significance. The presence of CAN increases the risk of developing HF nearly fivefold (RR = 4.92; p = 0.001), and the risk of HFpEF more than fivefold (RR = 5.50; 95% CI: 4.16–7.92; p = 0.0001).

Conclusion. In the present study, almost every second patient with DM2 had an undiagnosed CAN. The presence of CAN increased the chances of developing CHF by more than 5 times, while there was no significant effect on the risk of developing CHF with reduced and moderately reduced LV (CHF/nFV). Despite the growing understanding of the role of CAN, its prognostic significance and mechanisms in the development of specific cardiorenal complications remain the subject of active research.

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