Key Points
- This study aims to evaluate the predictive value of cardiac autonomic neuropathy on cardiovascular morbidity and mortality in type 1 diabetic patients with and without diabetic nephropathy.
- A prospective observational follow-up study of 197 type 1 diabetic patients with nephropathy and 191 matched patients with normoalbuminuria over 10.1 years.
- Cardiac autonomic neuropathy was assessed using heart rate variation (HRV) during deep breathing at baseline, predicting cardiovascular outcomes.
- The primary endpoint evaluated was cardiovascular morbidity and mortality, with secondary endpoints including all-cause mortality and progression of diabetic nephropathy.
- 40% of patients with nephropathy reached the primary endpoint compared to 10% in normoalbuminuric patients (P < 0.0001).
- Abnormal HRV at baseline significantly increased cardiovascular morbidity risk with an unadjusted HR of 7.7 in nephropathy patients (P = 0.004).
- Adjusted HR for reaching the primary endpoint was 6.4 for patients with nephropathy and abnormal HRV (P = 0.010).
Structured PICO
Does abnormal heart rate variation predict cardiovascular morbidity and mortality in type 1 diabetic patients with diabetic nephropathy?
PPopulation388 patients with type 1 diabetes, comprising 197 with diabetic nephropathy and 191 matched patients with long-standing type 1 diabetes and normoalbuminuria.
IInterventionAbnormal heart rate variation (HRV) (≤10 bpm) during deep breathing (indicator of cardiac autonomic neuropathy)
CComparatorNormal heart rate variation (HRV)
OOutcomeCardiovascular morbidity and mortalitycomposite
Cardiac autonomic neuropathy, assessed by abnormal heart rate variation, is a strong independent predictor of cardiovascular morbidity and mortality in type 1 diabetic patients with nephropathy.