Association of Chronic Vascular Complications of Diabetes With Cardiovascular Autonomic Neuropathy: The Silesia Diabetes-Heart Project.

BACKGROUND

Cardiovascular autonomic neuropathy (CAN) is a serious but frequently underdiagnosed complication of diabetes mellitus (DM). Increasing evidence suggests that CAN may coexist with other diabetes-related complications implicating the need for comprehensive screening and holistic risk assessment in people with DM.

OBJECTIVE

This study aimed to evaluate the relationship between selected microvascular and macrovascular complications of DM with CAN.

METHODS

This single-center observational study included 728 adults with DM (median age 56 (IQR 42, 67) years, 53% female) participating in the Silesia Diabetes-Heart Project. Clinical data, biochemical parameters, and the presence of diabetic vascular complications, namely diabetic retinopathy (DR), chronic kidney disease (CKD), and atherosclerotic cardiovascular disease (ASCVD) were collected. CAN was assessed using cardiovascular autonomic reflex tests (CARTs) in accordance with the Toronto Consensus criteria. Participants were classified as having no CAN, early CAN, or definite CAN. Associations between diabetic vascular complications and CAN were evaluated using multivariable logistic regression models.

RESULTS

CAN was present in 48.2% of participants (early CAN 32.4%, definite CAN 15.8%). Increasing CAN severity was associated with older age, longer DM duration, higher HbA1c and triglyceride levels, and impaired renal function (all p < 0.05). In multivariable analyses, CAN was independently associated with DR (2.26, 95% CI 1.25-4.19; p = 0.008), while the association with CKD remained borderline significant (OR 1.57, 95% CI 1.00-2.47; p = 0.049).

CONCLUSIONS

CAN is common in individuals with DM and is associated with microvascular complications, particularly DR, with a more modest association for CKD. These findings support the concept that CAN reflects systemic vascular injury in DM and highlight the importance of routine autonomic assessment especially in people with DR and CKD to identify those at increased risk of CAN.