C S Hansen1, J Fleischer2, D Vistisen1, M Ridderstråle3, J S Jensen4, M E Jørgensen1,5. 1. Department of Clinical Epidemiology, Steno Diabetes Centre A/S, Gentofte. 2. Medical Research Laboratories, Clinical Institute of Medicine, Aarhus University, Aarhus. 3. Patient Care Centre, Steno Diabetes Centre A/S, Gentofte. 4. Department of Cardiology, Gentofte Hospital, Gentofte. 5. National Institute of Public Health, Southern Denmark University, Denmark.
Abstract
AIM: To investigate the possible association between vitamin D deficiency and cardiovascular autonomic neuropathy in people with diabetes. METHODS: A total of 113 people with Type 1 or Type 2 diabetes [mean (interquartile range) diabetes duration 22.0 (12-31) years, mean (sd) age 56.2 (13.0) years, 58% men] underwent vitamin D (D2 and D3) assessment, and were screened for cardiovascular autonomic neuropathy using three cardiovascular reflex tests [heart rate response to deep breathing (E/I ratio), to standing (30/15 ratio) and to the Valsalva manoeuvre] and assessment of 5-min resting heart rate and heart rate variability indices. RESULTS: We found an inverse U-shaped association between serum vitamin D level and E/I ratio, 30/15 ratio and three heart rate variability indices (P < 0.05). Vitamin D level was non-linearly associated with cardiovascular autonomic neuropathy diagnosis (P < 0.05 adjusted for age and sex). Linear regression models showed that an increase in vitamin D level from 25 to 50 nmol/l was associated with an increase of 3.9% (95% CI 0.1;7.9) in E/I ratio and 4.8% (95% CI 4.7;9.3) in 30/15 ratio. Conversely, an increase from 125 to 150 nmol/l in vitamin D level was associated with a decrease of 2.6% (95% CI -5.8;0.1) and 4.1% (95% CI -5.8;-0.5) in the respective outcome measures. CONCLUSIONS: High and low vitamin D levels were associated with cardiovascular autonomic neuropathy in people with diabetes. Future studies should explore this association and the efficacy of treating dysvitaminosis D to prevent cardiovascular autonomic neuropathy.
AIM: To investigate the possible association between vitamin Ddeficiency and cardiovascular autonomic neuropathy in people with diabetes. METHODS: A total of 113 people with Type 1 or Type 2 diabetes [mean (interquartile range) diabetes duration 22.0 (12-31) years, mean (sd) age 56.2 (13.0) years, 58% men] underwent vitamin D (D2 and D3) assessment, and were screened for cardiovascular autonomic neuropathy using three cardiovascular reflex tests [heart rate response to deep breathing (E/I ratio), to standing (30/15 ratio) and to the Valsalva manoeuvre] and assessment of 5-min resting heart rate and heart rate variability indices. RESULTS: We found an inverse U-shaped association between serum vitamin D level and E/I ratio, 30/15 ratio and three heart rate variability indices (P < 0.05). Vitamin D level was non-linearly associated with cardiovascular autonomic neuropathy diagnosis (P < 0.05 adjusted for age and sex). Linear regression models showed that an increase in vitamin D level from 25 to 50 nmol/l was associated with an increase of 3.9% (95% CI 0.1;7.9) in E/I ratio and 4.8% (95% CI 4.7;9.3) in 30/15 ratio. Conversely, an increase from 125 to 150 nmol/l in vitamin D level was associated with a decrease of 2.6% (95% CI -5.8;0.1) and 4.1% (95% CI -5.8;-0.5) in the respective outcome measures. CONCLUSIONS: High and low vitamin D levels were associated with cardiovascular autonomic neuropathy in people with diabetes. Future studies should explore this association and the efficacy of treating dysvitaminosis D to prevent cardiovascular 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