Cardiovascular autonomic neuropathy linked to nephropathy, heart failure in type 2 diabetes
medwireNews: Findings from two studies presented at the virtual ADA 81st Scientific Sessions suggest that cardiovascular autonomic neuropathy (CAN) is associated with an increased risk for kidney function decline and heart failure in people with type 2 diabetes.
In the first study, Yaling Tang (Joslin Diabetes Center, Boston, Massachusetts, USA) and colleagues used data from the ACCORD trial to evaluate the association between CAN and estimated glomerular filtration rate (eGFR) in 6805 participants with available measurements.
Tang reported that the 1327 individuals with CAN at baseline experienced a significantly faster rate of eGFR decline during 5 years of follow-up compared with the 5478 people without CAN.
A total of 19.4% of people with CAN and 14.3% of those without experienced rapid kidney function decline, defined as annual eGFR loss of at least 5 mL/min per 1.73 m2, over the study period. In a model adjusting for factors including age, sex, baseline kidney function, glycated hemoglobin (HbA1c), and BMI, the presence of CAN was associated with a significantly higher risk for rapid kidney function decline, with an odds ratio of 1.39.
CAN was also associated with a significantly increased risk for experiencing a 40% decline in eGFR in a time-to-event analysis, with an adjusted hazard ratio of 1.40.
“Understanding the mechanisms underlying the association between cardiovascular autonomic neuropathy and kidney function loss may uncover new targets for interventions to prevent [end-stage kidney disease] in diabetes,” concluded Tang.
The second study, presented by Rodica Pop-Busui (University of Michigan, Ann Arbor, USA), investigated whether CAN was linked to heart failure risk in 6235 individuals with type 2 diabetes who participated in the DEVOTE trial, of whom 5.77% had CAN at baseline.
Pop-Busui said that the risk for heart failure hospitalization during approximately 1000 days of follow-up was significantly higher among people with versus without CAN at baseline, with a hazard ratio of 1.47 after adjustment for age, BMI, HbA1c, and ethnicity.
Conversely, there was no significant association between CAN and the risk for all-cause or cardiovascular mortality in the study.
The presenter concluded that “CAN may be used as a risk stratification tool in people with type 2 diabetes at risk of developing symptomatic heart failure.”
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