The Association Between Vascular Calcification and Subclinical Cardiac Autonomic Neuropathy in Type 1 Diabetes Mellitus Patients

Presentation Number: SAT 522
Date of Presentation: April 1st, 2017

Lía Nattero Chávez1, Alonso Sara1, Sandra Redondo López1, Marta Garnica Ureña1, Elena Fernández-Durán2, María Cortes Peiró3, Hector Francisco Escobar-Morreale*4 and Manuel Luque-Ramírez4
1Hospital Universitario Ramón y Cajal, Madrid, Spain, 2Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas CIBERDEM, Madrid, Spain, 3Diabetes, Obesity and Human Reproduction Research Group. Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBER Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Spanish Ministry of Science, Spain, 4Diabetes, Obesity and Human Reproduction Research Group. Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBER Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Spanish Ministry of Science, Madrid, Spain

Abstract

INTRODUCTION Even though a reduced ankle-brachial pressure index (ABPI) translates the presence of peripheral arterial stenosis, the relationship between medial artery calcification (MAC), as defined by an increased ABPI, and arteriosclerosis is unclear. Considering that cardiovascular autonomic neuropathy (CAN) is associated with arteriosclerotic disease in patients with type 1 diabetes mellitus (T1DM), this study aimed to explore the risk factors related to increased ABPI and its putative association with CAN in that population.

MATERIAL AND METHODS Observational cross-sectional study in a consecutive cohort of patients with T1DM from our Outpatient Clinic (n = 143). Clinical and biochemical variables were collected from their medical records. Systolic blood pressure (SBP) measurements were obtained using a Doppler ultrasound unit (8 MHz probe). ABPI was calculated by dividing ankle BP by brachial BP readings to provide a normalized ratio. MAC was defined by an ABPI > 1·2. CAN was assessed by the BP and heart rate (HR) responses to active standing (adrenergic innervation), and HR (RR interval) variability (parasympathetic innervarion): HR response to deep breathing (DB), to Valsalva’s maneuver (VAL), and to orthostatism [(ORT) 30:15 ratio].

RESULTS Mean age of patients was 37±12 yrs (range 18-79) and 61% were men. Mean body mass index (BMI) was 25 kg/m2. Age at T1DM diagnosis was 16±8 yr and average duration of disease was 21±11 yr. 16%, 32% and 28% of patients presented with concomitant hypertension, dyslipidemia, or were current smokers, respectively. Mean HbA1c was 7·6±1·3%. Eleven patients (8%) had an ABPI < 0·9 whereas 44 (31%) showed an ABPI > 1·2 suggestive of MAC. Patients with MAC were more likely male and were older that those with normal ABPI. They also had longer duration of disease, higher BMI, waist circumference and office SBP values compared with patients without MAC. A binary logistic regression model (Nagelkerke’s R2: 0·25, χ2: 27·15, P < 0.001) identified, as main determinants of MAC, male sex [Exp (B): 2·8 (1·2 - 6·8)], BMI [Exp (B): 1·2 (1·0 - 1·3], and duration of T1DM [Exp (B): 1·1 (1·0 - 1·1)]. Twenty-two (16%) patients presented with abnormal HR variability (64% and 59% of them had abnormal DB and ORT ratios, respectively). Patients with MAC showed significant lower SBP (P = 0·03) and diastolic BP (P = 0·02) responses to active standing (sympathetic dysautonomy), and a lower HRV response to DB (P = 0·06) (parasympathetic dysautonomy).

CONCLUSIONS Male sex, adiposity and duration of disease are related to MAC in our population with T1DM. The presence of parsympathetic and sympathetic dysautonomy in these patients with MAC also suggest a link between subclinical CAN and arterial calcification.

 

Nothing to Disclose: LN, AS, SR, MG, EF, MC, HFE, ML