This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Kempler, P. Search for Related Content Social Bookmarking                   What's this?

Review: Autonomic neuropathy: a marker of cardiovascular risk

Department of Medicine, Semmelweis University, 1083 Budapest, Korányi S.u. 2/a, Hungary, eva.kempet{at}ediport.hu

Cardiac autonomic neuropathy (CAN) represents a serious complication as it carries an approximately five-fold risk of mortality in patients with diabetes just as in those with chronic liver diseases. The high mortality rate may be related to silent myocardial infarction, cardiac arrhythmias, cardiovascular and cardiorespiratory instability and to other causes not yet explained. Resting tachycardia due to parasympathetic damage may represent one of the earliest signs. Typical findings referring to autonomic dysfunction may include exercise intolerance, orthostatic hypotension and cardiac dysfunction to rest or exercise. Severe autonomic neuropathy may be responsible for spontaneous respiratory arrest and unexplained sudden death. A relationship between the presence and/or severity of CAN and corrected QT interval prolongation is well documented. Better understanding of the prognostic importance of autonomic neuropathy followed the use of simple non-invasive cardiovascular reflex tests. These most commonly include heart rate variation in response to deep breathing, standing, the Valsalva maneouvre and blood pressure response to standing and sustained handgrip. Near normoglycaemia is now generally accepted as the primary approach to the prevention of diabetic neuropathy, but is not achievable in most patients. Our experience of the use of the antioxidant alpha-lipoic acid in the treatment of cardiac autonomic neuropathy is described.

Key Words: autonomic neuropathy • cardiovascular risk • QT interval • cardiovascular reflex tests • benfotiamin • alpha-lipoic acid.

The British Journal of Diabetes & Vascular Disease, Vol. 3, No. 2, 84-90 (2003)
DOI: 10.1177/14746514030030020201


CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?