The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: a meta-analysis.

Abstract:

OBJECTIVE:To examine by meta-analysis the relationship between cardiovascular autonomic neuropathy (CAN) and risk of mortality in individuals with diabetes. RESEARCH DESIGN AND METHODS:We searched Medline for English-language articles published from 1966 to 2001. Fifteen studies having a baseline assessment of cardiovascular autonomic function and mortality follow-up were identified. The analyses were stratified according to whether a single abnormality or two or more measures of cardiovascular autonomic function were used to define CAN. A global measure of association (i.e., relative risk) was generated for each group by pooling estimates across the studies using the Mantel-Haenszel procedure. RESULTS:CAN was significantly associated with subsequent mortality in both groups, although the magnitude of the association was stronger for those studies for which two or more measures were used to define CAN. The pooled relative risk for studies that defined CAN with the presence of two or more abnormalities was 3.45 (95% CI 2.66-4.47; P < 0.001) compared with 1.20 (1.02-1.41; P = 0.03) for studies that used one measure. CONCLUSIONS:These results support an association between CAN and increased risk of mortality. The stronger association observed in studies defining CAN by the presence of two or more abnormalities may be due to more severe autonomic dysfunction in these subjects or a higher frequency of other comorbid complications that contributed to their higher mortality risk. Future studies should evaluate whether early identification of subjects with CAN can lead to a reduction in mortality.

journal_name

Diabetes Care

journal_title

Diabetes care

authors

Maser RE,Mitchell BD,Vinik AI,Freeman R

doi

10.2337/diacare.26.6.1895

subject

Has Abstract

pub_date

2003-06-01 00:00:00

pages

1895-901

issue

6

eissn

0149-5992

issn

1935-5548

journal_volume

26

pub_type

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