Impaired Autonomic Function Is Associated With Increased Mortality, Especially in Subjects With Diabetes, Hypertension, or a History of Cardiovascular Disease

• Published in: Diabetes care Vol. 24; no. 10; pp. 1793 - 1798
• Main Authors: Gerritsen, Jeanet, Dekker, Jacqueline M., TenVoorde, Ben J., Kostense, Piet J., Heine, Robert J., Bouter, Lex M., Heethaar, Rob M., Stehouwer, Coen D.A.
• Format: Journal Article
• Language: English
• Published: American Diabetes Association 01.10.2001
• Subjects: Diabetes; Diabetic neuropathies; Diagnosis; Dysautonomia; Health aspects; United States
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.24.10.1793

Impaired Autonomic Function Is Associated With Increased Mortality, Especially in Subjects With Diabetes, Hypertension, or a History of Cardiovascular Disease The Hoorn Study Jeanet Gerritsen , MSC 1 , Jacqueline M. Dekker , PHD 2 , Ben J. TenVoorde , PHD 1 , Piet J. Kostense , PHD 3 , Robert J. Heine , MD 2 , Lex M. Bouter , PHD 2 , Rob M. Heethaar , PHD 1 and Coen D.A. Stehouwer , MD 2 1 Department of Clinical Physics and Informatics, Vrije Universiteit, Amsterdam 2 Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam 3 Department of Epidemiology and Biostatistics, Vrije Universiteit, Amsterdam, the Netherlands Abstract OBJECTIVE —Measures of baroreflex sensitivity, heart rate variability (HRV), and the classical Ewing test parameters are currently used for the diagnosis of diabetic autonomic neuropathy and for mortality risk stratification after myocardial infarction. However, the strengths of the associations of these measures of autonomic function with risk of mortality have never been compared in one study population. Furthermore, no evidence is available on the possible effect of glucose tolerance on these associations. RESEARCH DESIGN AND METHODS —The study population ( n = 605) consisted of a glucose tolerance–stratified sample from a general population (50–75 years of age). Cardiac cycle duration and continuous finger arterial pressure were measured under two conditions: at rest and on metronome breathing. From these readings, seven parameters of autonomic function were assessed (one Ewing, five HRV, and one baroreflex sensitivity). RESULTS —During 9 years of follow-up, 101 individuals died, 43 from cardiovascular causes. Subjects with diabetes and low levels of the autonomic function parameters, indicating impaired autonomic function, had an approximately doubled risk of mortality. This association was consistent, though not statistically significant, for all parameters. The elevated risk was not observed in subjects without diabetes, hypertension, or prevalent cardiovascular disease. CONCLUSIONS —Impaired autonomic function is associated with all-cause and cardiovascular mortality. Moreover, the results of the present study suggest that cardiac autonomic dysfunction in patients already at risk (diabetes, hypertension, or history of cardiovascular disease) may be especially hazardous. BRS, baroreflex sensitivity EI, expiration-inspiration HF, high-frequency HRV, heart rate variability IGT, impaired glucose tolerance LF, low-frequency NN, normal-to-normal NGT, normal glucose tolerance SDNN, standard deviation of all normal-to-normal (sinus rhythm) R-R intervals Footnotes Address correspondence and reprint requests to Jacqueline M. Dekker, Institute for Research in Extramural Medicine, Faculty of Medicine, Vrije Universiteit, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. E-mail: jm.dekker.emgo{at}med.vu.nl . Received for publication 27 February 2001 and accepted in revised form 6 July 2001. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.