Prevalence and prognostic significance of cardiac autonomic neuropathy in community-based people with type 2 diabetes: the Fremantle Diabetes Study Phase II
Authors' conclusion
Routine screening for CAN in type 2 diabetes has limited clinical but some prognostic value.
Study context
- Population
- Community-based people with T2D in FDS2, screened at baseline with standardised cardiovascular reflex tests (CARTs) (deep breathing, Valsalva, standing); mean age 62.3 years, 55.3% males, median diabetes duration 7.3 years830 analysed
- Participants
- 1,254 people
- Exposure
- Definite vs possible vs no cardiac autonomic neuropathy (CAN)
- Outcome
- Prevalence of CAN (no/possible/definite) and its prognostic significance (incident HF, IHD, all-cause mortality)
- Follow-up
- Baseline
Methodological detailsFremantle Diabetes Study Phase II, longitudinal, community-based
- Fremantle Diabetes Study Phase II
- Longitudinal
- Community-based
Main finding
As reported in the abstract
CAN prevalence
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| All-cause mortalityPossible CANvs No CAN | 1.47 (1.01–2.14) | P = 0.046 | |
| All-cause mortalityDefinite CANvs No CAN | 2.42 (1.60–3.67) | P < 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
All-cause mortality
- Kaplan-Meier: graded increase in all-cause mortality risk from no CAN to possible and definite CAN (P < 0.001)
Incident ischaemic heart disease (IHD) and heart failure (HF)
- Kaplan-Meier: definite CAN associated with a lower likelihood of incident IHD and HF vs no/possible CAN (P < 0.001)
- CAN category not a significant independent predictor of IHD (P ≥ 0.851) or HF (P ≥ 0.342) in most parsimonious models
Independent associates of definite CAN
- Longer diabetes duration, higher BMI and resting pulse rate, antidepressant and antihypertensive therapies, albuminuria, distal sensory polyneuropathy, prior HF
Original publication
Prevalence and prognostic significance of cardiac autonomic neuropathy in community-based people with type 2 diabetes: the Fremantle Diabetes Study Phase II. Cardiovasc Diabetol. Published 18 March 2024. doi:10.
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