Non-motor symptoms in Parkinson’s disease: A systematic review of cardiac implications

Background: Parkinson’s disease is a progressive neurodegenerative condition not only marked by motor impairment but also by a wide range of non-motor symptoms, such as cardiovascular complications. Cardiac dysfunction, traditionally ascribed to autonomic nervous system damage, is now more and more identifi ed as a major cause of morbidity and mortality in PD patients. The present review intends to integrate current evidence regarding the cardiac manifestations of PD, highlighting their prevalence, mechanisms, and clinical relevance. Methods: A PRISMA-guided systematic review was carried out using the PECOS framework. Seven electronic databases were searched for articles published between January 2010 and January 2025 that explored cardiac involvement as a non-motor symptom in PD. The inclusion criteria included observational studies, clinical trials, and meta-analyses reporting on cardiac outcomes like orthostatic hypotension, arrhythmias, heart rate variability, and cardiovascular mortality. Data extraction and risk of bias evaluation were carried out independently by two reviewers. Results: Starting with a pool of 949 records, 20 studies were found to meet the inclusion criteria. These studies showed a uniform correlation between PD and enhanced cardiovascular risks, including stroke (up to OR 1.66), orthostatic hypotension, and decreased heart rate variability. Though some reports described a decreased risk of myocardial infarction (OR 0.80), autonomic dysfunction was the core mechanism underlying most cardiac events. The results also highlighted the need for individualized cardiovascular monitoring in the management of Parkinson’s disease and indicated underutilization of diagnostic technologies such wearable sensors and HRV analysis. Conclusion: Cardiac failure in Parkinson’s disease (PD), fueled by autonomic dysfunction, is underappreciated in spite of associations with hypotension, arrhythmias, and stroke. Early detection measures such as HRV and wearables are not utilized. Cardiovascular risk reduction, particularly with PD meds, and incorporating cardiac management can better enhance outcomes.