Diabetic Cardiovascular Autonomic Neuropathy: Diagnosis and Treatment

Aim. To systematize modern data on risk factors, clinical picture, diagnostics of diabetic cardiovascular autonomic neuropathy (CAN), and to highlight the main directions of its prevention and treatment.

Key points. CAN (autonomic cardiovascular neuropathy) is a form of diabetic autonomic neuropathy in which, due to damage to sympathetic and/or parasympathetic fibers, the regulation of cardiac activity and vascular tone is impaired. Despite a significant increase in the risk of cardiovascular disease, CAN often remains unrecognized, which leads to the development of heart rhythm disturbances, vascular tone disorders and increases the risk of death from all causes. Among all forms of diabetic neuropathy, it is CAN that is associated with the highest mortality. The risk of CAN increases by 6% per year in type 1 diabetes mellitus (DM) and by 2% per year in type 2 DM. The main factor of pathogenesis is chronic hyperglycemia, leading to oxidative stress and accumulation of advanced glycation end products, which damage first the parasympathetic and then the sympathetic link of the autonomic nervous system. Damage to autonomic regulation in CAN is always characterized by persistent and, as a rule, drug-resistant disorders. Persistent tachycardia in combination with painless myocardial ischemia significantly increases the risk of death from myocardial infarction and its complications. Diagnostics of CAN is currently based mainly on functional tests that can only detect an advanced process; sensitive and specific examination methods that allow assessing the initial manifestations of CAN are only being developed. Drugs that would have proven efficacy in relation to CAN are also not registered at present, but achieving target glycemia values can significantly slow down its progression. Modern drugs with neuroprotective properties can also have a positive effect on the initial manifestations of CAN.

Conclusion. Early detection and prevention of CAN are important clinical tasks. Currently, the key factor in preventing the development and progression of CAN is maintaining normal glycemia. The study of the effect of new classes of drugs on the course of CAN is ongoing; the data obtained suggest the possibility of some preventive potential for CAN in modern hypoglycemic drugs with a neuroprotective effect. 

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