Review: Diabetic autonomic dysfunction: adverse effects on presentation,management and outcomes of acute coronary syndromes

Abstract

n acute coronary syndromes there is increasing speculation that autonomic dysfunction complicating diabetes may adversely affect outcomes. Mechanisms are unclear but the potential effects on the timing of plaque events, the mode of presentation, myocardial oxygen demand and arrhythmogenesis are discussed in this article.

Keywords

diabetes acute coronary syndromes autonomic neuropathy.

Get full access to this article

View all access options for this article.

References

Töyry JP , Niskanen LK , Mäntysaari MJ , Länsimies EA , Uusitupa MIJ. Occurrence, predictors, and clinical significance of autonomic neuropathy in NIDDM: ten-year follow-up from the diagnosis. Diabetes 1996;45: 308-15.

Jamerson KA , Julius S. , Gudbrandsson T. , Andersson O. , Brant DO Reflex sympathetic activation induces acute insulin resistance in the human forearm. Hypertension 1993;21:618-23.

Jamerson KA , Smith SD , Amerena JV , Grant E. , Julius S. Vasoconstriction with norepinephrine causes less forearm insulin resistance than a reflex sympathetic vasoconstriction. Hypertension 1994;23:1006-11.

Huggett RJ , Scott EM , Gilbey SG , Stoker JB , Mackintosh AF , Mary DA Impact of type 2 diabetes mellitus on sympathetic neural mechanisms in hypertension . Circulation 2003;108:3097-101.

Brunner EJ , Hemingway H. , Walker BR et al. Adrenocortical, autonomic, and inflammatory causes of the metabolic syndrome: nested case-control study. Circulation 2002;106:2659-65.

Stone PH , Muller JE , Hartwell T. et al. The effect of diabetes mellitus on prognosis and serial left ventricular function after acute myocardial infarction: contribution of both coronary disease and diastolic left ventricular dysfunction to the adverse prognosis. The MILIS Study Group. J Am Coll Cardiol 1989;14:49-57.

Granger CB , Califf RM , Young S. et al., and The Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) Study Group. Outcome of patients with diabetes mellitus and acute myocardial infarction treated with thrombolytic agents. J Am Coll Cardiol 1993;21:920-5.

Woodfield SL , Lundergan CF , Reiner JS et al. Angiographic findings and outcome in diabetic patients treated with thrombolytic therapy for acute myocardial infarction: the GUSTO-I experience. J Am Coll Cardiol 1996;28:1661-9.

Mak KH , Moliterno DJ , Granger CB et al. Influence of diabetes mellitus on clinical outcome in the thrombolytic era of acute myocardial infarction. GUSTO-I Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries . J Am Coll Cardiol 1997;30:171-9

10.

Robertson W. , Strong J. Atherosclerosis in persons with hypertension and diabetes mellitus. Lab Invest 1968;18:538-51.

11.

Hamby R. , Sherman L. , Mehta J. , Aintablian A. Reappraisal of the role of the diabetic state in coronary artery disease . Chest 1976;70:251-7.

12.

Waller B. , Palumbo B. , Roberts W. Status of the coronary arteries at necropsy in diabetes mellitus with onset after age 30 years. Am J Med 1980;69:498-506.

13.

Kass DA , Saeki A. , Tunin RS , Recchia FA Adverse influence of systemic vascular stiffening on cardiac dysfunction and adaptation to acute coronary occlusion. Circulation 1996;93:1533-41.

14.

Watanabe H. , Ohtsuka S. , Kakihana M. , Sugishita Y. Coronary circulation in dogs with an experimental decrease in aortic compliance. J Am Coll Cardiol 1993;21:1497-506.

15.

Di Carli MF , Bianco-Batlles D. , Landa ME , Kazmers A. , Groehn H. , Muzik O. , Grunberger G. Effects of autonomic dysfunction on coronary blood flow in patients with diabetes mellitus . Circulation 1999;100:813-19.

16.

Foo K. , Sekhri N. , Knight C. , Deaner A. , Ranjadayalan K. , Cooper J. , Timmis AD Effects of diabetes on heart rate and other determinants of myocardial oxygen demand in acute coronary syndromes. Diabet Med 2004;21: 1025-31.

17.

Ziegler D. Diabetic cardiovascular autonomic neuropathy: prognosis, diagnosis and treatment . Diabetes Metab Rev 1994;10:339-83.

18.

Heidland UE , Strauer BE Left ventricular muscle mass and elevated heart rate are associated with coronary plaque disruption. Circulation 2001; 104:1477-82.

19.

Hjalmarson A. , Gilpin EA , Kjekshus J. et al. Influence of heart rate on mortality after acute myocardial infarction. Am J Cardiol 1990;65:547-53.

20.

Zuanetti G. , Mantini L. , Hernandez-Bernal F. et al. Relevance of heart rate as a prognostic factor in patients with acute myocardial infarction: insights from the GISSI-2 study. Eur Heart J 1998;19(suppl F):F19-F26.

21.

Copie X. , Hnatkova K. , Staunton A. , Fei L. , Camm AJ , Malik M. Predictive power of increased heart rate versus depressed left ventricular ejection fraction and heart rate variability for risk stratification after myocardial infarction. Results of a two-year follow-up study. J Am Coll Cardiol 1996; 27:270-6.

22.

Malmberg K. , Herlitz J. , Hjalmarson A. , Ryden L. Effects of metoprolol on mortality and late infarction in diabetics with suspected acute myocardial infarction. Retrospective data from two large studies. Eur Heart J 1989 ; 10:423-8.

23.

Muller JE , Stone PH , Turi ZG et al. Circadian variation in the frequency of onset of acute myocardial infarction. N Engl J Med 1985;313:1315-22.

24.

Marchant B. , Ranjadayalan K. , Stevenson R. , Wilkinson P. , Timmis AD Circadian and seasonal factors in the pathogenesis of acute myocardial infarction: the influence of environmental temperature . Br Heart J 1993; 69:385-7.

25.

Sayer JW , Wilkinson P. , Ranjadayalan K. , Ray S. , Marchant B. , Timmis AD Attenuation or absence of circadian and seasonal rhythms of acute myocardial infarction. Br Heart J 1997;77:325-9.

26.

Uretsky BF , Farquhar D. , Berezin A. , Hood W. Symptomatic myocardial infarction without chest pain: prevalence and clinical course. Am J Cardiol 1977;40:498-503.

27.

Araz M. , Celen Z. , Akdemir I. , Okan V. Frequency of silent myocardial ischemia in type 2 diabetic patients and the relation with poor glycemic control. Acta Diabetol 2004;41:38-43.

28.

Marchant B. , Umachandran V. , Stevenson R. , Kopelman PG , Timmis AD Silent myocardial ischaemia: the role of subclinical dysfunction in patients with and without diabetes. J Am Coll Cardiol 1993;22:1433-7.

29.

Ottesen MM , Kober L. , Jorgensen S. , Torp-Pedersen C. , for the TRACE study group. Determinants of delay between symptoms and hospital admission in 5978 patients with acute myocardial infarction. Europ Heart J 1996;17:429-37.

30.

Barakat K. , Wells Z. , Ramdhany S. , Mills PG , Timmis AD Bangladeshi patients present with non-classical features of AMI and are treated less aggressively in the East End of London. Heart 2003;89:276-9.

31.

Gerritsen J. , Dekker JM , TenVoorde BJ 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 ;24:1793-8.

32.

Vaishnav S. , Stevenson R. , Marchant B. , Ranjadayalan K. , Timmis AD The relation between heart rate variability early after acute myocardial infarction and long-term mortality. Am J Cardiol 1994 ;73:653-7.

33.

Ewing DJ , Boland O. , Neilson JMM , Cho CG , Clarke BF Autonomic dysfunction, QT lengthening, and unexpected deaths in male diabetic patients. Diabetologia 1991;34:182-5.

34.

Bellavere F. , Ferri M. , Guarini L. et al. Prolonged QT period in diabetic autonomic dysfunction: a possible role in sudden cardiac death. Br Heart J 1988;59:379-83.

35.

Foo K. , Sekhri N. , Deaner A. , Knight C. , Ranjadayalan K. , Timmis AD Effects of diabetes on serum potassium concentrations in acute coronary syndromes . Heart 2003;89:31-5.

36.

Weston PJ , Gill GV Is undetected autonomic dysfunction responsible for sudden death in type 1 diabetes mellitus? The `dead in bed' syndrome revisited. Diabet Med 1999;16:626-31.

37.

Ranjadayalan K. , Umachandran V. , Ambepityia G. , Kopelman PG , Mills PG , Timmis AD Prolonged anginal perceptual threshold in diabetes: effects on exercise capacity and myocardial ischemia. J Am Coll Cardiol 1990; 16:1120-4.

38.

Ambepityia G. , Kopelman PG , Ingram D. , Swash M. , Mills PG , Timmis AD Exertional myocardial ischemia in diabetes: a quantitative analysis of anginal perceptual threshold and the influence of autonomic funtion. J Am Coll Cardiol 1990 ;15:72-7.