Key result
An albumin-adjusted serum calcium level <8.87 mg/dl was associated with a significantly increased risk of declined heart rate variability in patients with type 2 diabetes (OR 0.049).
Why the study?
Heart rate variability measurement to detect cardiovascular autonomic neuropathy is inconvenient in most clinics, creating a need for easier measurements to identify high-risk T2DM patients.
Does lower albumin-adjusted serum calcium predict declined heart rate variability in patients with type 2 diabetes mellitus?
Cross-Sectional (n=675)
No
Does lower albumin-adjusted serum calcium predict declined heart rate variability in patients with type 2 diabetes mellitus?
Lower albumin-adjusted serum calcium, even within the normal range, is independently associated with declined heart rate variability and worse cardiac diastolic function in patients with type 2 diabetes.
Low albumin-adjusted calcium was associated with declined HRV in T2DM; hypothesis-generating and should not yet change practice.
Background Cardiovascular autonomic neuropathy (CAN) is common in patients with type 2 diabetes mellitus (T2DM), mainly presented as decreased heart rate variability (HRV) which often leads to cardiac death. However, HRV measurement is not convenient in most clinics. Therefore, identifying high-risk patients for CAN in diabetes with easier measurements is crucial for the early intervention and prevention of catastrophic consequences. Methods In this cross-sectional study, 675 T2DM patients with normocalcemia were selected. Of these, they were divided into two groups: normal HRV group (n = 425, 100 ms≤ SDNN ≤180 ms) vs . declined HRV group (n = 250, SDNN <100 ms). All patients’ clinical data were collected and the correlation of clinical variables with HRV were analyzed by correlation and logistic regression analysis. The area below the ROC curve was used to evaluate the predictive performance of serum calcium on HRV. Results In this study, declines in HRV were present in 37.0% of T2DM patients. Significant differences in albumin-adjusted serum calcium levels (CaA) (8.86 ± 0.27 vs. 9.13 ± 0.39 mg/dl, p < 0.001) and E/A (0.78 ± 0.22 vs. 0.83 ± 0.26, p = 0.029) were observed between declined HRV and normal HRV groups. Bivariate linear correlation analysis showed that CaA and E/A were positively correlated with HRV parameters including SDNN ( p < 0.001), SDNN index ( p < 0.001), and Triangle index ( p < 0.05). The AUC in the ROC curve for the prediction of CaA on HRV was 0.730 (95% CI (0.750–0.815), p < 0.001). The cutoff value of CaA was 8.87 mg/dl (sensitivity 0.644, specificity 0.814). The T2DM patients with CaA <8.87 mg/dl had significantly lower HRV parameters (SDNN, SDNN index, rMSSD, and triangle index) than those with CaA ≥8.87 mg/dl ( p < 0.01, respectively). Multivariate logistic regression analysis showed a significantly increased risk of declined HRV in subjects with CaA level <8.87 mg/dl [OR (95% CI), 0.049 (0.024–0.099), p < 0.001]. Conclusions Declined HRV is associated with a lower CaA level and worse cardiac function. The serum calcium level can be used for risk evaluation of declined HRV in T2DM patients even within the normocalcemic range.
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Wang et al. (2022) conducted a cross-sectional in Type 2 diabetes mellitus with normocalcemia (n=675). Albumin-adjusted serum calcium (CaA) <8.87 mg/dl vs. CaA ≥8.87 mg/dl was evaluated on Declined heart rate variability (SDNN <100 ms) (OR 0.049, 95% CI 0.024-0.099, p=<0.001). An albumin-adjusted serum calcium level <8.87 mg/dl was associated with a significantly increased risk of declined heart rate variability in patients with type 2 diabetes (OR 0.049).
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