There is a paucity of contemporary data on the prevalence and prognostic significance of cardiac autonomic neuropathy (CAN) from community-based cohorts with type 2 diabetes assessed using gold standard methods. The aim of this study was to assess these aspects of CAN in the longitudinal observational Fremantle Diabetes Study Phase II (FDS2). FDS2 participants were screened at baseline using standardised cardiovascular reflex tests (CARTs) of heart rate variation during deep breathing, Valsalva manoeuvre and standing. CAN (no/possible/definite) was assessed from the number of abnormal CARTs. Multinomial regression identified independent associates of CAN status. Cox proportional hazards modelling determined independent baseline predictors of incident heart failure (HF) and ischaemic heart disease (IHD), and all-cause mortality. Of 1254 participants assessed for CAN, 86 (6.9%) were outside CART age reference ranges and valid CART data were unavailable for 338 (27.0%). Of the remaining 830 (mean age 62.3 years, 55.3% males, median diabetes duration 7.3 years), 51.0%, 33.7% and 15.3% had no, possible or definite CAN, respectively. Independent associates of definite CAN (longer diabetes duration, higher body mass index and resting pulse rate, antidepressant and antihypertensive therapies, albuminuria, distal sensory polyneuropathy, prior HF) were consistent with those reported previously. In Kaplan–Meier analysis, definite CAN was associated with a lower likelihood of incident IHD and HF versus no/possible CAN (P < 0.001) and there was a graded increase in all-cause mortality risk from no CAN to possible and definite CAN (P < 0.001). When CAN category was added to the most parsimonious models, it was not a significant independent predictor of IHD (P ≥ 0.851) or HF (P ≥ 0.342). Possible CAN (hazard ratio (95% CI) 1.47 (1.01, 2.14), P = 0.046) and definite CAN (2.42 (1.60, 3.67), P < 0.001) increased the risk of all-cause mortality versus no CAN. Routine screening for CAN in type 2 diabetes has limited clinical but some prognostic value.

中文翻译：

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社区 2 型糖尿病患者心脏自主神经病变的患病率和预后意义：弗里曼特尔糖尿病研究 II 期

使用金标准方法评估的社区 2 型糖尿病队列中关于心脏自主神经病变 (CAN) 患病率和预后意义的当代数据很少。本研究的目的是在纵向观察弗里曼特尔糖尿病研究 II 期 (FDS2) 中评估 CAN 的这些方面。使用标准化心血管反射测试 (CART) 对 FDS2 参与者进行基线筛查，以检测深呼吸、瓦尔萨尔瓦动作和站立期间的心率变化。CAN（否/可能/确定）是根据异常 CART 的数量来评估的。多项回归确定了 CAN 状态的独立关联。Cox 比例风险模型确定了心力衰竭 (HF) 和缺血性心脏病 (IHD) 以及全因死亡率的独立基线预测因子。在接受 CAN 评估的 1254 名参与者中，86 人 (6.9%) 超出了 CART 年龄参考范围，并且 338 人 (27.0%) 无法获得有效的 CART 数据。其余 830 名患者（平均年龄 62.3 岁，55.3% 为男性，中位糖尿病病程 7.3 年）中，分别有 51.0%、33.7% 和 15.3% 没有、可能或明确患有 CAN。明确 CAN 的独立相关因素（较长的糖尿病病程、较高的体重指数和静息脉率、抗抑郁和抗高血压治疗、白蛋白尿、远端感觉性多发性神经病、既往心力衰竭）与之前报道的一致。在 Kaplan-Meier 分析中，与不存在/可能存在 CAN 相比，明确的 CAN 与较低的 IHD 和 HF 发生可能性相关（P < 0.001），并且全因死亡风险从不存在 CAN 到可能且明确的 CAN 呈分级增加（ P < 0.001）。当 CAN 类别添加到最简约的模型中时，它并不是 IHD (P ≥ 0.851) 或 HF (P ≥ 0.342) 的显着独立预测因子。与无 CAN 相比，可能的 CAN（风险比（95% CI）1.47（1.01，2.14），P = 0.046）和明确的 CAN（2.42（1.60，3.67），P < 0.001）增加了全因死亡的风险。2 型糖尿病中 CAN 的常规筛查临床有限，但具有一定的预后价值。