Stephanie G Wheeler1, Jessie H Ahroni, Edward J Boyko. 1. Primary and Specialty Care Service, Veterans Affairs Puget Sound Health Care System, Seattle Division, 1660 South Columbian Way, Seattle, WA 98108, USA. stephanie.wheeler@med.va.gov
Abstract
OBJECTIVE: The objective of this study is to evaluate whether autonomic neuropathy predicts short term all-cause mortality in an elderly cohort of veteran patients with diabetes. RESEARCH DESIGN AND METHODS: All of the diabetic patients receiving primary care at one VA medical center were eligible for participation, between 1990 and 1997. One thousand and fifteen patients were identified, of whom 14% declined to participate, so that a total of 843 diabetic patients were enrolled. Autonomic neuropathy was evaluated by heart rate response to timed deep breathing. One hundred and fifty one patients have died since the onset of the study. RESULTS: Mean follow-up was 42.4 months. Subjects who died had greater diabetes duration compared with survivors (13.1 vs. 11.4 years, P=0.04) but were comparable with regards to type of diabetes and mean glycosylated hemoglobin level. The Cox proportional hazards analysis, adjusting for age, smoking status, creatinine, pack-years of cigarettes smoked, diabetes duration, race, history of ischemic heart disease and hypertension showed that those patients with the lowest quintile of heart rate variability had a significantly increased risk of mortality (hazard ratio=1.49, 95% confidence limits 1.01-2.19). CONCLUSIONS: This study supports the hypothesis that decreased heart rate variability is an independent risk factor for mortality in diabetic patients followed in a primary care setting.
OBJECTIVE: The objective of this study is to evaluate whether autonomic neuropathy predicts short term all-cause mortality in an elderly cohort of veteran patients with diabetes. RESEARCH DESIGN AND METHODS: All of the diabeticpatients receiving primary care at one VA medical center were eligible for participation, between 1990 and 1997. One thousand and fifteen patients were identified, of whom 14% declined to participate, so that a total of 843 diabeticpatients were enrolled. Autonomic neuropathy was evaluated by heart rate response to timed deep breathing. One hundred and fifty one patients have died since the onset of the study. RESULTS: Mean follow-up was 42.4 months. Subjects who died had greater diabetes duration compared with survivors (13.1 vs. 11.4 years, P=0.04) but were comparable with regards to type of diabetes and mean glycosylated hemoglobin level. The Cox proportional hazards analysis, adjusting for age, smoking status, creatinine, pack-years of cigarettes smoked, diabetes duration, race, history of ischemic heart disease and hypertension showed that those patients with the lowest quintile of heart rate variability had a significantly increased risk of mortality (hazard ratio=1.49, 95% confidence limits 1.01-2.19). CONCLUSIONS: This study supports the hypothesis that decreased heart rate variability is an independent risk factor for mortality in diabeticpatients followed in a primary care setting.
Authors: Christian Stevns Hansen; Kristine Færch; Marit Eika Jørgensen; Marek Malik; Daniel R Witte; Eric J Brunner; Adam G Tabák; Mika Kivimäki; Dorte Vistisen Journal: Diabetes Care Date: 2019-04-02 Impact factor: 19.112
Authors: David S Siscovick; Nona Sotoodehnia; Thomas D Rea; Trivellore E Raghunathan; Xavier Jouven; Rozenn N Lemaitre Journal: Rev Endocr Metab Disord Date: 2010-03 Impact factor: 6.514