USA: Study on Cardiovascular Autonomic Neuropathy in Type 2 Diabetes

Treatment with tighter blood sugar and blood pressure targets decreases risk of cardiovascular autonomic neuropathy (CAN) in type 2 diabetes (T2D) patients at high risk for cardiovascular events, finds a recent study in the journal Diabetes Care. The results were obtained from posthoc analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study.

The effective preventive interventions for CAN remain unclear. Yaling Tang, Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts, and colleagues therefore, examined the effect of intensively treating traditional risk factors for CAN, including dyslipidemia, hypertension, and hyperglycemia in patients with type 2 diabetes and high cardiovascular risk participating in the ACCORD trial.

CAN was defined as heart rate variability indices below the fifth percentile of the normal distribution. 71% (n = 7,275) of 10,251 ACCORD participants underwent a CAN evaluation at study entry and at least once after randomization. Using generalized linear mixed models, the effects of intensive interventions on CAN were analyzed among these subjects.

Key findings of the study include:

• As compared with standard intervention, intensive glucose treatment reduced CAN risk by 16% (odds ratio [OR] 0.84)—an effect driven by individuals without cardiovascular disease (CVD) at baseline (OR 0.73) rather than those with CVD (OR 1.10).
• Intensive blood pressure (BP) intervention decreased CAN risk by 25% (OR 0.75), especially in patients ≥65 years old (OR 0.66).
• Fenofibrate did not have a significant effect on CAN (OR 0.91).

"These data confirm a beneficial effect of intensive glycemic therapy and demonstrate, for the first time, a similar benefit of intensive BP control on CAN in T2D. A negative CVD history identifies T2D patients who especially benefit from intensive glycemic control for CAN prevention," wrote the authors.

"Intensive Risk Factor Management and Cardiovascular Autonomic Neuropathy in Type 2 Diabetes: The ACCORD Trial," is published in the journal Diabetes Care.

DOI: https://care.diabetesjournals.org/content/early/2020/11/02/dc20-1842