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Cardiovascular autonomic dysfunction is associated with central obesity in persons with impaired glucose tolerance

Authors

  • T. Laitinen,

    1. Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital
    2. Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland, Kuopio
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  • J. Lindström,

    1. Diabetes Unit, Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute, Helsinki, Finland
    2. Department of General Practice and Primary Health Care, University of Helsinki
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  • J. Eriksson,

    1. Unit of General Practice, Helsinki University Central Hospital
    2. Folkhälsan Research Centre, Helsinki
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  • P. Ilanne-Parikka,

    1. Research Unit of Tampere University Hospital
    2. Diabetes Center, Finnish Diabetes Association, Tampere
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  • S. Aunola,

    1. Living Conditions, Health and Wellbeing Unit, National Institute for Health and Welfare, Turku
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  • S. Keinänen-Kiukaanniemi,

    1. Institute of Health Sciences (General Practice), University of Oulu
    2. Unit of General Practice, Oulu University Hospital, Oulu
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  • J. Tuomilehto,

    1. Diabetes Unit, Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute, Helsinki, Finland
    2. Department of General Practice and Primary Health Care, University of Helsinki
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  • M. Uusitupa

    1. Institute of Public Health and Clinical Nutrition, Department of Clinical Nutrition, University of Eastern Finland, Kuopio
    2. Research Unit, Kuopio University Hospital, Kuopio, Finland
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Professor Tomi Laitinen MD, Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Puijonlaaksontie 2, PO Box 1777, FIN-70211 Kuopio, Finland.
E-mail Tomi.Laitinen@kuh.fi

Abstract

Diabet. Med. 28, 699–704 (2011)

Abstract

Aims  The aim of this study was to investigate the prevalence of cardiovascular autonomic neuropathy in persons with previously diagnosed impaired glucose tolerance and to characterize associations between components of metabolic syndrome and cardiovascular autonomic neuropathy in the Finnish Diabetes Prevention Study cohort.

Methods  Two hundred and sixty-eight individuals with impaired glucose tolerance at baseline in the Finnish Diabetes Prevention Study, but not diagnosed with diabetes during follow-up, were studied for cardiovascular autonomic neuropathy. At the second annual follow-up visit after the end of lifestyle intervention, we performed deep-breathing and active orthostatic tests to detect possible parasympathetic and sympathetic dysfunction. To describe metabolic characteristics, anthropometric measurements, an oral glucose tolerance test and assessments for HbA1c, serum lipids and blood pressure were carried out.

Results  Prevalence of parasympathetic dysfunction was 25% and prevalence of sympathetic dysfunction was 6%, with no difference between the former intervention and control group participants or between men and women. Subjects with parasympathetic dysfunction were older, more obese (weight, waist circumference, body mass index) and had higher triglyceride concentration compared with those with normal parasympathetic function (P < 0.01 for all). Parasympathetic dysfunction was not significantly associated with other characteristics of metabolic syndrome; for example, high cholesterol, glucose and insulin levels or HbA1c. Correlations between the Expiration/Inspiration (E/I) ratio (the longest heart beat duration in expiration divided by the shortest heart beat duration in inspiration) and measures reflecting obesity were statistically significant in the pooled population and in men but not in women.

Conclusions  Cardiovascular autonomic neuropathy is common in persons with impaired glucose tolerance. Obesity, especially among men, seems to play an important role in the early pathogenesis of cardiovascular autonomic neuropathy.

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