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Determinants and prognostic value of cardiovascular autonomic function in coronary artery disease patients with and

Jaana J Karjalainen1, Antti M Kiviniemi, Arto J Hautala

  • 1Corresponding author: Mikko Paavo Tulppo, mikko.tulppo@verve.fi.

Diabetes Care
|August 21, 2013
PubMed

Insights

Cardiovascular autonomic dysfunction in coronary artery disease (CAD) patients with type 2 diabetes (T2D) predicts short-term events. However, exercise capacity is a stronger predictor of autonomic function than hs-CRP is of cardiovascular events.

Area of Science:

  • Cardiology
  • Endocrinology
  • Autonomic Neuroscience

Background:

  • Cardiovascular autonomic dysfunction is prevalent in patients with coronary artery disease (CAD) and type 2 diabetes (T2D).
  • The prognostic significance of autonomic dysfunction in this specific patient group remains unclear.
  • Understanding these relationships is crucial for risk stratification and management.

Purpose of the Study:

  • To investigate the associations between measures of autonomic function (HRR, SDNN, HRT) and clinical, metabolic, and inflammatory variables in CAD patients.
  • To determine the predictive value of autonomic function for cardiovascular events in CAD patients with and without T2D.
  • To compare the predictive power of autonomic markers with established risk factors like hs-CRP.

Main Methods:

  • A cohort of 1,060 CAD patients (50% with T2D) underwent assessment of heart rate recovery (HRR), 24-h heart rate variability (SDNN), and heart rate turbulence (HRT).
  • Associations with echocardiographic, metabolic, inflammatory, and risk variables, as well as exercise capacity, were examined.
  • A 2-year follow-up evaluated a composite endpoint of cardiovascular death, acute coronary event, stroke, and heart failure hospitalization.

Main Results:

  • Exercise capacity was a significant predictor of HRR, SDNN, and HRT in the overall CAD cohort.
  • In univariate analysis, reduced HRR, SDNN, and HRT were associated with the composite endpoint, but only in patients with T2D.
  • After multivariate adjustment, autonomic markers did not independently predict the endpoint, whereas high-sensitivity C-reactive protein (hs-CRP) remained a significant independent predictor.

Conclusions:

  • Cardiovascular autonomic function in CAD patients is linked to exercise capacity and other clinical factors.
  • Autonomic dysfunction is a significant short-term predictor of cardiovascular events specifically in CAD patients with T2D.
  • While indicative of risk, autonomic dysfunction is not as strong an independent predictor of adverse cardiovascular outcomes as hs-CRP in this population.

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