Cardiovascular Dysautonomia and Sudden Cardiac Death in Parkinson’s Disease: Emerging Clinical Insights and Implications for Care

Parkinson's disease (PD) is the second most common neurodegenerative disorder worldwide. In addition to its cardinal motor features-bradykinesia rigidity and resting tremor-PD is frequently preceded by mild subclinical cardiac autonomic dysfunction such as reduced heart rate variability, constipation and reduced metaiodobenzylguanidine uptake with more severe autonomic failure such as neurogenic orthostatic hypotension and urogenital failure occurring later in the disease. Beyond the substantial morbidity associated with advanced disease, individuals with PD have a 1.617-fold increased risk of all-cause mortality compared with the general population, with cardiovascular disease representing a major contributor to this excess risk. The relationship between cardiovascular autonomic dysfunction and mortality in PD has been widely investigated, though important gaps remain. This review synthesizes current evidence on cardiovascular autonomic manifestations of PD, discusses implications for clinical management, and highlights cardiovascular dysautonomia as a priority area for future mechanistic and therapeutic research.