Diabetic autonomic neuropathy and cardiovascular risk. Pittsburgh Epidemiology of Diabetes Complications Study III

Arch Intern Med. 1990 Jun;150(6):1218-22.


Diabetic autonomic neuropathy (DAN) has been shown to confer a high risk of mortality. The association between DAN and cardiovascular risk factors was examined in a well-defined cohort of 25- to 34-year-old insulin-dependent diabetes mellitus subjects (n = 168) with and without DAN as evaluated by heart rate response to deep breathing, standing, and the Valsalva maneuver. The autonomic tests were performed using both an office-based procedure and a method employed by the Diabetes Control and Complications Trial with analyses performed by the Diabetes Research and Analysis Association, Lexington, Ky. Good agreement was found between the procedures for the assessment modalities of heart rate response to deep breathing. Modeling potential correlates in logistic analyses, where heart rate response to deep breathing was the dependent variable, revealed hypertension status, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and gender (female) to be independent determinants of DAN. These results suggest that traditional cardiovascular risk factors are important correlates of DAN and may relate to both its cause and poor prognosis. Since these results are from a cross-sectional study, prospective follow-up of this cohort will be needed for confirmation.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Autonomic Nervous System Diseases / epidemiology
  • Autonomic Nervous System Diseases / physiopathology*
  • Cardiovascular Diseases / complications*
  • Cardiovascular Diseases / physiopathology
  • Cholesterol / metabolism
  • Cohort Studies
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / physiopathology
  • Diabetic Neuropathies / epidemiology
  • Diabetic Neuropathies / physiopathology*
  • Female
  • Heart Rate
  • Humans
  • Hypertension / complications
  • Incidence
  • Male
  • Multivariate Analysis
  • Regression Analysis
  • Reproducibility of Results
  • Risk Factors
  • Valsalva Maneuver / physiology


  • Cholesterol