OBJECTIVE: To assess the role of beta cell failure in the development of autonomic dysfunction in patients with coronary artery disease. DESIGN: Autonomic function was measured by standard clinical methods and by heart rate variability in 24 type II diabetic and 24 non-diabetic subjects with coronary artery disease. Quantitative estimates of pancreatic beta cell function (%beta) and insulin resistance were made from basal plasma glucose and insulin concentrations using a computer solved model. Fasting proinsulin levels provided an independent measure of beta cell function. RESULTS: The circadian rhythm of sympathovagal balance (ratio of low to high frequency spectral components of heart rate variability) was significantly attenuated in patients with below median (%beta </= 63. 3) compared with above median pancreatic beta cell function. Multiple measures of autonomic function showed positive associations with %beta (low frequency: r = 0.41, p = 0.004; high frequency: r = 0.27, p = 0.07; lying/standing fall in systolic pressure: r = -0.30, p = 0.04) and negative associations with proinsulin (low frequency: r = -0.35, p = 0.03; high frequency: r = -0.36, p = 0.02; standard deviation of RR intervals: r = -0.43, p = 0.007). Associations tended to be stronger in non-diabetic than diabetic patients. In contrast, there was no association between insulin resistance and either autonomic function or the circadian rhythm of sympathovagal balance, regardless of diabetes status. CONCLUSIONS: The data are consistent with the hypothesis that beta cell failure plays a pathogenic role in the development of autonomic dysfunction in patients with coronary artery disease.
OBJECTIVE: To assess the role of beta cell failure in the development of autonomic dysfunction in patients with coronary artery disease. DESIGN: Autonomic function was measured by standard clinical methods and by heart rate variability in 24 type II diabetic and 24 non-diabetic subjects with coronary artery disease. Quantitative estimates of pancreatic beta cell function (%beta) and insulin resistance were made from basal plasma glucose and insulin concentrations using a computer solved model. Fasting proinsulin levels provided an independent measure of beta cell function. RESULTS: The circadian rhythm of sympathovagal balance (ratio of low to high frequency spectral components of heart rate variability) was significantly attenuated in patients with below median (%beta </= 63. 3) compared with above median pancreatic beta cell function. Multiple measures of autonomic function showed positive associations with %beta (low frequency: r = 0.41, p = 0.004; high frequency: r = 0.27, p = 0.07; lying/standing fall in systolic pressure: r = -0.30, p = 0.04) and negative associations with proinsulin (low frequency: r = -0.35, p = 0.03; high frequency: r = -0.36, p = 0.02; standard deviation of RR intervals: r = -0.43, p = 0.007). Associations tended to be stronger in non-diabetic than diabeticpatients. In contrast, there was no association between insulin resistance and either autonomic function or the circadian rhythm of sympathovagal balance, regardless of diabetes status. CONCLUSIONS: The data are consistent with the hypothesis that beta cell failure plays a pathogenic role in the development of autonomic dysfunction in patients with coronary artery disease.
Authors: D K Nagi; T J Hendra; A J Ryle; T M Cooper; R C Temple; P M Clark; A E Schneider; C N Hales; J S Yudkin Journal: Diabetologia Date: 1990-09 Impact factor: 10.122
Authors: L Bernardi; L Ricordi; P Lazzari; P Soldá; A Calciati; M R Ferrari; I Vandea; G Finardi; P Fratino Journal: Circulation Date: 1992-11 Impact factor: 29.690