Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
J Cardiovasc Transl Res. 2012 Aug;5(4):463-78. doi: 10.1007/s12265-012-9367-6. Epub 2012 May 30.
Cardiovascular autonomic neuropathy (CAN) in diabetes is generally overlooked in practice, although awareness of its serious consequences is emerging. Challenges in understanding the complex, dynamic changes in the modulation of the sympathetic/parasympathetic systems' tone and their interactions with physiologic mechanisms regulating the control of heart rate, blood pressure, and other cardiovascular functions in the presence of acute hyper-or-hypoglycemic stress, other stressors or medication, and challenges with sensitive evaluations have contributed to lower CAN visibility compared with other diabetes complications. Yet, CAN is a significant cause of morbidity and mortality, due to a high-risk of cardiac arrhythmias, silent myocardial ischemia and sudden death. While striving for aggressive risk factor control in diabetes practice seemed intuitive, recent reports of major clinical trials undermine established thinking concerning glycemic control and cardiovascular risk. This review covers current understanding and gaps in that understanding of the clinical implications of CAN and prevention and treatment of CAN.
糖尿病患者的心血管自主神经病变（CAN）在实践中通常被忽视，尽管人们已经意识到其严重后果。在急性高血糖或低血糖应激、其他应激源或药物存在的情况下，理解交感/副交感系统张力调节的复杂、动态变化及其与调节心率、血压和其他心血管功能的生理机制相互作用的复杂性、敏感性评估的挑战，导致与其他糖尿病并发症相比，CAN 的可见度较低。然而，由于心律失常、无症状性心肌缺血和猝死的风险较高，CAN 是发病率和死亡率的一个重要原因。尽管在糖尿病实践中努力积极控制危险因素是合理的，但最近的大型临床试验报告颠覆了人们对血糖控制和心血管风险的既定看法。这篇综述涵盖了目前对 CAN 的临床意义以及 CAN 的预防和治疗的理解和理解差距。
