An association analysis of lipid profile and diabetic cardiovascular autonomic neuropathy in a Chinese sample

Lige Song, Linuo Zhou, Zihui Tang, Lige Song, Linuo Zhou, Zihui Tang

Abstract

Background: Recent studies have shown that triglyceride (TG), low-density lipoprotein cholesterol (LDL), and high-density lipoprotein cholesterol (HDL) are related to the prevalence of cardiovascular autonomic neuropathy (CAN). However, little is known about the association of lipid profile with diabetic cardiovascular autonomic neuropathy (DCAN), or its severity in the Chinese population. The purpose of this study is to explore the extent of this phenomenon using a Chinese sample.

Methods: A subgroup analysis on 455 diabetic patients with undiagnosed DCAN was performed to evaluate the relationships of lipids profile and DCAN. DCAN was diagnosed if there were at least two abnormal cardiovascular autonomic reflex test results, based on short-term heart rate variability tests. Multivariable logistic regression (MLR)was carried out to control potential confounders for determining the independent association of variables with DCAN in different models.

Results: MLR analysis indicated that TG was significantly and independently associated with DCAN when controlling for confounding factors (P < 0.1 for two models). Additionally, TG combined with TC (LRS-1) and LDL (LRS-2) was associated with this outcome (P < 0.1 for LRS-1 and LRS-2).

Conclusion: Our findings indicate that TG and the severity of lipids profile is significantly and independently associated with DCAN, respectively.

Trial registration: ClinicalTrials.gov Identifier: NCT02461472 , retrospectively registered 2 Jun, 2015.

Keywords: Association; Chinese sample; Diabetic cardiac autonomic neuropathy; Lipid profile.

Figures

Fig. 1
Fig. 1
Comparison of prevalence of diabetic cardiovascular autonomic neuropathy (DCAN) according to serum total cholesterol (TC). a: Comparison of DCAN prevalence according to TC with trinary variables. DCAN prevalence was 27.01 %, 28.87 % and 33.33 % in the three groups, respectively. No significant differences among the three groups were reported (P = 0.452). b: Comparison of DCAN prevalence according to TC with binary variables. DCAN prevalence was 27.76 % and 33.33 % in the two groups, respectively. No significant differences between the two groups were reported (P = 0.122)
Fig. 2
Fig. 2
Comparison of prevalence of diabetic cardiovascular autonomic neuropathy (DCAN) according to triglyceride (TG). a: Comparison of DCAN prevalence according to TG with trinary variables. DCAN prevalence was 25.34 %, 29.13 % and 35.25 % in the three groups, respectively. A significant differences among the three groups were reported (P =0.022 and P for trend = 0.006). b: Comparison of DCAN prevalence according to TG with binary variables. DCAN prevalence was 26.54 % and 35.25 % in the two groups, respectively. A significant differences between the two groups were reported (P = 0.010)
Fig. 3
Fig. 3
Comparison of prevalence of diabetic cardiovascular autonomic neuropathy (DCAN) according tolow density lipoprotein cholesterol (LDL). a: Comparison of DCAN prevalence according to LDL with trinary variables. DCAN prevalence was 28.40 %,28.13 % and 32.86 % in the three groups, respectively. No significant differences among the three groups were reported (P =0.622). b: Comparison of DCAN prevalence according to LDL with binary variables. DCAN prevalence was 28.31 % and 32.86 % in the two groups, respectively. A significant differences between the two groups were reported (P = 0.276)
Fig. 4
Fig. 4
Comparison of prevalence of diabetic cardiovascular autonomic neuropathy (DCAN) according tohigh-density lipoprotein cholesterol (HDL). Comparison of DCAN prevalence according to HDL. DCAN prevalence was 28.89%n and 29.47 % in the two groups, respectively. There were no significant differences between the two groups (P = 0.371)
Fig. 5
Fig. 5
Comparison of prevalence of diabetic cardiovascular autonomic neuropathy (DCAN) according to lipid profile risk score (LRS). a: Comparison of DCAN prevalence according to LRS-1. DCAN prevalence was 25.48 %, 32.70 % and 37.84 % in the three groups, respectively. There were significant differences among the three groups (P for difference = 0.018 and P for a trend =0.005). b: Comparison of DCAN prevalence according to LRS-2. DCAN prevalence was 26.18 %, 32.08 % and 42.86 % in the four groups, respectively. There were significant differences among the three groups (P for difference = 0.024 and P for a trend =0.007). c: Comparison of DCAN prevalence according to LRS-3. DCAN prevalence was 27.14 %,30.14 % and 37.50 % in the three groups, respectively. There were no significant differences among the three groups (P for difference = 0.140 and P for a trend =0.059). d: Comparison of DCAN prevalence according to LRS-4. DCAN prevalence was 28.14 %, 30.32 % and 40.00 % in the three groups, respectively. There were no significant differences among the four groups (P for difference =0.548 and P for a trend =0.363)

References

    1. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet. 1997;349:1498–1504. doi: 10.1016/S0140-6736(96)07492-2.
    1. Murray CJ, Ezzati M, Flaxman AD, Lim S, Lozano R, et al. GBD 2010: a multi-investigator collaboration for global comparative descriptive epidemiology. Lancet. 2012;380:2055–2058. doi: 10.1016/S0140-6736(12)62134-5.
    1. He J, Gu D, Reynolds K, Wu X, Muntner P, et al. Serum total and lipoprotein cholesterol levels and awareness, treatment, and control of hypercholesterolemia in China. Circulation. 2004;110:405–411. doi: 10.1161/01.CIR.0000136583.52681.0D.
    1. Yan L, Xu MT, Yuan L, Chen B, Xu ZR, et al. Prevalence of dyslipidemia and its control in type 2 diabetes: A multicenter study in endocrinology clinics of China. J Clin Lipidol. 2016;10:150–160. doi: 10.1016/j.jacl.2015.10.009.
    1. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011;128(Suppl 5):S213-56. doi:10.1542/peds.2009-2107C.
    1. Adair LS, Gordon-Larsen P, Du SF, Zhang B, Popkin BM. The emergence of cardiometabolic disease risk in Chinese children and adults: consequences of changes in diet, physical activity and obesity. Obesity Reviews. 2014;15(Suppl 1):49–59. doi: 10.1111/obr.12123.
    1. Yang W, Lu J, Weng J, Jia W, Ji L, et al. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362:1090–1101. doi: 10.1056/NEJMoa0908292.
    1. He J, Gu D, Wu X, Reynolds K, Duan X, et al. Major causes of death among men and women in China. N Engl J Med. 2005;353:1124–1134. doi: 10.1056/NEJMsa050467.
    1. Yang Z, Xing X, Xiao J, Lu J, Weng J, et al. Prevalence of cardiovascular disease and risk factors in the Chinese population with impaired glucose regulation: the 2007–2008 China national diabetes and metabolic disorders study. Experimental and clinical endocrinology & diabetes : official journal. German Society of Endocrinology [and] German Diabetes Association. 2013;121:372–374. doi: 10.1055/s-0033-1341520.
    1. Grundy SM, Balady GJ, Criqui MH, Fletcher G, Greenland P, et al. Primary prevention of coronary heart disease: guidance from Framingham: a statement for healthcare professionals from the AHA Task Force on Risk Reduction. American Heart Association Circulation. 1998;97:1876–1887.
    1. Jang EH, Park YM, Hur J, Kim MK, Ko SH, et al. Higher levels of small dense low-density lipoprotein (LDL) are associated with cardiac autonomic neuropathy in patients with type 2 diabetes. Diabetic Med. 2013;30:694–701. doi: 10.1111/dme.12176.
    1. Ge X, Chen H, Zhang K, Tang ZH. The analysis of blood pressure profiles and their severity in relation to diabetic cardiovascular autonomic neuropathy in the Chinese population: preliminary analysis. J Endocrinol Invest. 2016;39(8):891-8. doi:10.1007/s40618-016-0444-6.
    1. Tang ZH, Zeng F, Li Z, Zhou L. Association and predictive value analysis for resting heart rate and diabetes mellitus on cardiovascular autonomic neuropathy in general population. J Diabetes Res. 2014;2014:215473.
    1. Spallone V, Ziegler D, Freeman R, Bernardi L, Frontoni S, Pop-Busui R, Stevens M, Kempler P, Hilsted J, Tesfaye S, Low P, Valensi P; Toronto Consensus Panel on Diabetic Neuropathy. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metab Res Rev. 2011;27(7):639-53. doi:10.1002/dmrr.1239.
    1. Zeng F, Tang ZH, Li Z, Yu X, Zhou L. Normative reference of short-term heart rate variability and estimation of cardiovascular autonomic neuropathy prevalence in Chinese people. J Endocrinol Invest. 2014;37(4):385-91. doi:10.1007/s40618-013-0047-4.
    1. Tang ZH, Zeng F, Yu X, Zhou L. Bayesian estimation of cardiovascular autonomic neuropathy diagnostic test based on baroreflex sensitivity in the absence of a gold standard. Int J Cardiol. 2014;171:e78–80. doi: 10.1016/j.ijcard.2013.11.100.
    1. Gerritsen J, Dekker JM, TenVoorde BJ, Kostense PJ, Heine RJ, et al. Impaired autonomic function is associated with increased mortality, especially in subjects with diabetes, hypertension, or a history of cardiovascular disease: the Hoorn Study. Diabetes Care. 2001;24:1793–1798. doi: 10.2337/diacare.24.10.1793.
    1. Maser RE, Mitchell BD, Vinik AI, Freeman R. The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: a meta-analysis. Diabetes Care. 2003;26:1895–1901. doi: 10.2337/diacare.26.6.1895.
    1. The effect of intensive diabetes therapy on the development and progression of neuropathy. The Diabetes Control and Complications Trial Research Group. Ann Intern Med. 1995;122(8):561-8.
    1. Kempler P, Tesfaye S, Chaturvedi N, Stevens LK, Webb DJ, et al. Autonomic neuropathy is associated with increased cardiovascular risk factors: the EURODIAB IDDM Complications Study. Diabetic Med. 2002;19:900–909. doi: 10.1046/j.1464-5491.2002.00821.x.
    1. Spallone V, Ziegler D, Freeman R, Bernardi L, Frontoni S, et al. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metab Res Rev. 2011;27:639–653. doi: 10.1002/dmrr.1239.
    1. Riihimaa PH, Suominen K, Knip M, Tapanainen P, Tolonen U. Cardiovascular autonomic reactivity is decreased in adolescents with Type 1 diabetes. Diabetic Med. 2002;19:932–938. doi: 10.1046/j.1464-5491.2002.00816.x.
    1. Leiter LA. The prevention of diabetic microvascular complications of diabetes: is there a role for lipid lowering? Diabetes Res Clin Pract. 2005;68(Suppl 2):S3–14. doi: 10.1016/j.diabres.2005.03.015.
    1. Tesfaye S, Chaturvedi N, Eaton SE, Ward JD, Manes C, et al. Vascular risk factors and diabetic neuropathy. N Engl J Med. 2005;352:341–350. doi: 10.1056/NEJMoa032782.
    1. Tesfaye S. Advances in the management of painful diabetic neuropathy. Clin Med. 2007;7:113–114. doi: 10.7861/clinmedicine.7-2-113.
    1. Wiggin TD, Sullivan KA, Pop-Busui R, Amato A, Sima AA, et al. Elevated triglycerides correlate with progression of diabetic neuropathy. Diabetes. 2009;58:1634–1640. doi: 10.2337/db08-1771.
    1. Vincent AM, Hinder LM, Pop-Busui R, Feldman EL. Hyperlipidemia: a new therapeutic target for diabetic neuropathy. J Peripheral Nervous System. 2009;14:257–267. doi: 10.1111/j.1529-8027.2009.00237.x.
    1. Voulgari C, Psallas M, Kokkinos A, Argiana V, Katsilambros N, et al. The association between cardiac autonomic neuropathy with metabolic and other factors in subjects with type 1 and type 2 diabetes. J Diabetes Complications. 2011;25:159–167. doi: 10.1016/j.jdiacomp.2010.06.001.
    1. Laitinen T, Lindstrom J, Eriksson J, Ilanne-Parikka P, Aunola S, et al. Cardiovascular autonomic dysfunction is associated with central obesity in persons with impaired glucose tolerance. Diabetic Med. 2011;28:699–704. doi: 10.1111/j.1464-5491.2011.03278.x.
    1. Witte DR, Tesfaye S, Chaturvedi N, Eaton SE, Kempler P, et al. Risk factors for cardiac autonomic neuropathy in type 1 diabetes mellitus. Diabetologia. 2005;48:164–171. doi: 10.1007/s00125-004-1617-y.
    1. Pop-Busui R, Sima A, Stevens M. Diabetic neuropathy and oxidative stress. Diabetes Metab Res Rev. 2006;22:257–273. doi: 10.1002/dmrr.625.
    1. Vincent AM, Russell JW, Low P, Feldman EL. Oxidative stress in the pathogenesis of diabetic neuropathy. Endocr Rev. 2004;25:612–628. doi: 10.1210/er.2003-0019.
    1. Ozay R, Uzar E, Aktas A, Uyar ME, Gurer B, et al. The role of oxidative stress and inflammatory response in high-fat diet induced peripheral neuropathy. J Chem Neuroanat. 2014;55:51–57. doi: 10.1016/j.jchemneu.2013.12.003.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다