Cardiovascular autonomic neuropathy defined by indices of heart rate variability is associated with cardiovascular disease: a longitudinal cohort study of participants with type 1 diabetes
Main finding · First occurrence of any-CVDResult — go to the resultHazard ratio 2.37 95% CI 1.43,3.94Authors' conclusion
The prevalence of and risk factors for standard resting ECG-derived CAN were similar to previously reported estimates from CARTs. CVD risk was significantly higher in those with vs. without CAN. These data support future studies examining the diagnostic utility of HRV indices at the point of care for risk stratification.
Study context
- Population
- Adults with T1D from the Epidemiology of Diabetes Interventions and Complications (EDIC) study, 2015–2022; mean ± SD age 56.2 ± 6.8 years, T1D duration 34.7 ± 7.9 years, 48% female
- Participants
- 997 adults
- Exposure
- Electrocardiogram (ECG)-derived cardiovascular autonomic neuropathy (CAN) vs no CAN
- Outcome
- First occurrence of any-CVD
- Follow-up
- 7 years
Methodological detailsannual standard resting ECG recordings, CAN defined by heart rate variability (HRV) indices (SDNN, rMSSD) with cut-offs validated against cardiovascular reflex tests (CARTs)
- Annual standard resting ECG recordings
- CAN defined by HRV indices (SDNN, rMSSD) with cut-offs validated against CARTs
Main finding
As reported in the abstract
Hazard ratio
2.37
95% CI 1.43,3.94
CANvs No CAN
HR 2.37 (95% CI 1.43,3.94)
Observational data: associations, not effects.
Further findings
Prevalence of ECG-derived CAN
- Prevalence of ECG-derived CAN, stable
- ≈64%
Risk factors for CAN
- Higher pulse rate, OR [95% CI] per 1 bpm
- 1.08 [1.07,1.10]
- HbA1c, OR [95% CI] per 1%
- 1.43 [1.29,1.58]
- Followed by older age, male sex, higher albumin excretion rate and hypertension history
Original publication
Cardiovascular autonomic neuropathy defined by indices of heart rate variability is associated with cardiovascular disease: a longitudinal cohort study of participants with type 1 diabetes. Cardiovasc Diabetol. Published 13 August 2025. doi:10.
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