Cardiovascular autonomic neuropathy

Cardiovascular autonomic neuropathy (CAN) is common among patients with DM and is correlated with an increased 5-year mortality rate from CVD. The clinical manifestations of CAN are resting tachycardia, postural hypotension, exercise intolerance, abnormal coronary vasomotor regulation, increased QT interval, and perioperative instability. Collectively, the clinical manifestations of CAN are related to an increased risk of renal disease, stroke, CVD and sudden death. The development and progression of CAN are likely related to the dysregulation of the autonomic nervous system (ANS) with increased sympathetic activity and elevated inflammatory markers. As the ANS is responsible for maintaining the activity of the sinus node, end diastolic volume, end systolic volume and systemic vascular resistance, ANS dysfunction can lead to arterial stiffness, left ventricular hypertrophy and ventricular diastolic dysfunction. The incidence of CAN increases with age and inadequate glycaemic control, which places patients with DM at a higher risk of developing both CAN and CVD.

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