Thal Serge C, Shityakov Sergey, Salvador Ellaine, Förster Carola Y
Department of Anesthesiology, Helios University Hospital, Witten/Herdecke University, 42283 Wuppertal, Germany.
Laboratory of Chemoinformatics, Infochemistry Scientific Center, ITMO University, 197101 Saint-Petersburg, Russia.
Biomolecules. 2025 Mar 29;15(4):499. doi: 10.3390/biom15040499.
Patients with type 2 diabetes mellitus (T2DM) predominantly experience mortality due to cardiovascular diseases (CVD), particularly in low- and middle-income nations. Among these, heart failure (HF) is the most severe cardiovascular complication in terms of prognosis and management. Despite advancements in individualized glycemic control and cardiovascular risk management, including the development of novel glucose- and lipid-lowering agents, the prevalence of HF in T2DM patients remains persistently high. This indicates that factors beyond hyperglycemia significantly contribute to the heightened risk of HF associated with T2DM. This review examines critical factors influencing CVD risk in T2DM, particularly the roles of reduced heart rate variability (HRV), a marker of autonomic dysfunction, and chronic inflammation, both of which play pivotal roles in HF pathogenesis. Recent evidence highlights the potential of vagus nerve activation to modulate these risk factors, underscoring its capacity to reduce T2DM-related cardiovascular complications. Specifically, we discuss the therapeutic promise of transcutaneous auricular vagus nerve stimulation (taVNS) as a non-invasive intervention to enhance vagal tone, decrease systemic inflammation, and improve cardiovascular outcomes in T2DM. By addressing the interplay among HRV, microvascular disease, and inflammation, this review provides a comprehensive perspective on the potential utility of taVNS in managing HF in T2DM.
2型糖尿病（T2DM）患者主要死于心血管疾病（CVD），在低收入和中等收入国家尤其如此。其中，心力衰竭（HF）是预后和管理方面最严重的心血管并发症。尽管在个体化血糖控制和心血管风险管理方面取得了进展，包括新型降糖和降脂药物的研发，但T2DM患者中HF的患病率仍然居高不下。这表明，高血糖以外的因素显著增加了T2DM患者发生HF的风险。本综述探讨了影响T2DM患者CVD风险的关键因素，特别是心率变异性（HRV）降低（自主神经功能障碍的一个指标）和慢性炎症的作用，这两者在HF发病机制中都起着关键作用。最近的证据凸显了迷走神经激活调节这些风险因素的潜力，强调了其降低T2DM相关心血管并发症的能力。具体而言，我们讨论了经皮耳迷走神经刺激（taVNS）作为一种非侵入性干预措施的治疗前景，它可以增强迷走神经张力、减轻全身炎症并改善T2DM患者的心血管结局。通过阐述HRV、微血管疾病和炎症之间的相互作用，本综述全面探讨了taVNS在管理T2DM患者HF方面的潜在效用。
