Cardiovascular Autonomic Neuropathy and Cardiovascular Outcomes in the DCCT/EDIC Study
November 2016. This analysis of patients in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) evaluated whether cardiovascular autonomic neuropathy (CAN) is an independent risk factor for cardiovascular disease (CVD). A series of standardized cardiovascular autonomic reflex tests was performed at DCCT baseline, every 2 years during the DCCT, and at 2 times during EDIC follow-up. At the DCCT closeout, 10% of patients without CAN versus 25% with CAN had experienced CVD (hazard ratio for time to first CVD event: 2.79, 95% CI 1.91–4.09). During the subsequent EDIC follow-up, the cumulative incidence of first-occurrence CVD events remained significantly higher in patients with CAN at DCCT closeout, and this association maintained statistical significance after adjustment for multiple risk factors. Investigators concluded that patients with diagnosed CAN during the DCCT had a greater long-term risk of CVD events over time, and that this association is not independent of glycemic exposure or metabolic memory.