Chan-Hee Jung1, Sang-Hee Jung2, Kyu-Jin Kim3, Bo-Yeon Kim3, Chul-Hee Kim3, Sung-Koo Kang3, Ji-Oh Mok4. 1. Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, Soonchunhyang University, Bucheon, South Korea Contributed equally to this article. 2. Department of Obstetrics and Gynecology, School of Medicine, Cha University, Bundang, South Korea Contributed equally to this article. 3. Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, Soonchunhyang University, Bucheon, South Korea. 4. Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, Soonchunhyang University, Bucheon, South Korea hanna@schmc.ac.kr.
Abstract
OBJECTIVE: This study evaluates cardiac autonomic neuropathy and heart rate variability according to the vitamin D status in type 2 diabetes mellitus. METHODS: A total of 163 patients were recruited. Cardiac autonomic neuropathy was assessed using five tests according to Ewing's protocol. The time and frequency domains of the heart rate variability were also evaluated. Patients were separated into three groups: vitamin D sufficient [25(OH)D ⩾ 20 ng/mL], vitamin D insufficient [10 ⩽ 25(OH)D < 20] and vitamin D deficiency [25(OH)D < 10] groups. RESULTS: Both standard deviation of normal-to-normal RR intervals and square root of the average of the sum of the squares of the differences between adjacent NN intervals in the supine position were significantly lower in vitamin D deficient group. Low frequency/high frequency ratio in the upright position was significantly higher in the vitamin D deficient group. 25(OH)D levels are positively correlated with standard deviation of normal-to-normal RR intervals in the supine position. In multivariate logistic analysis, patients with vitamin D levels of 10 < 25(OH)D < 20 ng/mL showed borderline significantly lower cardiac autonomic neuropathy risk than those with 25(OH)D levels <10 ng/mL (odds ratio = 0.45 (0.23-1.01), p = 0.051). CONCLUSION: Vitamin D deficiency was significantly correlated with heart rate variability parameters. However, there was only borderline significant association between vitamin D concentration and presence of cardiac autonomic neuropathy. Therefore, future studies are required to establish a relationship between vitamin D levels and cardiac autonomic neuropathy.
OBJECTIVE: This study evaluates cardiac autonomic neuropathy and heart rate variability according to the vitamin D status in type 2 diabetes mellitus. METHODS: A total of 163 patients were recruited. Cardiac autonomic neuropathy was assessed using five tests according to Ewing's protocol. The time and frequency domains of the heart rate variability were also evaluated. Patients were separated into three groups: vitamin D sufficient [25(OH)D ⩾ 20 ng/mL], vitamin D insufficient [10 ⩽ 25(OH)D < 20] and vitamin D deficiency [25(OH)D < 10] groups. RESULTS: Both standard deviation of normal-to-normal RR intervals and square root of the average of the sum of the squares of the differences between adjacent NN intervals in the supine position were significantly lower in vitamin D deficient group. Low frequency/high frequency ratio in the upright position was significantly higher in the vitamin D deficient group. 25(OH)D levels are positively correlated with standard deviation of normal-to-normal RR intervals in the supine position. In multivariate logistic analysis, patients with vitamin D levels of 10 < 25(OH)D < 20 ng/mL showed borderline significantly lower cardiac autonomic neuropathy risk than those with 25(OH)D levels <10 ng/mL (odds ratio = 0.45 (0.23-1.01), p = 0.051). CONCLUSION:Vitamin D deficiency was significantly correlated with heart rate variability parameters. However, there was only borderline significant association between vitamin D concentration and presence of cardiac autonomic neuropathy. Therefore, future studies are required to establish a relationship between vitamin D levels and cardiac autonomic neuropathy.
Authors: Lilian de Souza D'Albuquerque Silva; Natércia Neves Marques de Queiroz; Franciane Trindade Cunha de Melo; João Felício Abrahão Neto; Luísa Corrêa Janaú; Norberto Jorge Kzan de Souza Neto; Manuela Nascimento de Lemos; Maria Clara Neres Iunes de Oliveira; Angélica Leite de Alcântara; Lorena Vilhena de Moraes; Wanderson Maia da Silva; Ícaro José Araújo de Souza; Nivin Mazen Said; Gabriela Nascimento de Lemos; Karem Miléo Felício; Márcia Costa Dos Santos; Ana Regina Bastos Motta; Melissa de Sá Oliveira Dos Reis; Isabel Jane Campos Lobato; Priscila Boaventura Barbosa de Figueiredo; Ana Carolina Contente Braga de Souza; Pedro Paulo Freire Piani; João Soares Felício Journal: Front Endocrinol (Lausanne) Date: 2020-11-19 Impact factor: 5.555