Comparison of microalbuminuria and heart rate variability in prediction of cardiovascular complications in diabetic population: a pilot study

Authors

  • K. Deepalakshmi Department of Physiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
  • S. Vijayabaskaran Department of Physiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
  • A. Murali Department of Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20172278

Keywords:

Autonomic imbalance, Diabetes mellitus, Heart rate variability, Microalbuminuria

Abstract

Background: Microalbuminuria is considered as an early marker and strongly associated with risk of cardiovascular complications in diabetic patients. Autonomic imbalance due to micro vascular damage to parasympathetic and sympathetic fibers results in reduced heart rate variability; also predicts increased risk for cardiovascular events in diabetics. Hence it is necessary to identify an early and effective predictor of diabetic micro vascular complications. Objective of the study was to compare heart rate variability of controls with type 2 diabetes with and without microalbuminuria.

Methods: This comparative study was conducted among individuals without diabetes, hypertension and dyslipidemia (controls) and Type II diabetics with and without microalbuminuria (cases). Cases and controls were subjected to general clinical examination; microalbuminuria and HbA1C were noted. heart rate variability was assessed using digital physiograph. Frequency (HF, LF, LF/HF ratio) domain readings were noted.

Results: Mann Whitney U test was employed to analyze nonparametric data. Diabetics with microalbuminuria when compared with controls showed statistically significant (p-value=0.015) reduction in vagal activity. When compared with diabetics without microalbuminuria (180.4±151.7) they showed reduction in HF with no statistical significance. When diabetic group without microalbuminuria (0.56±0.31) was compared with controls they showed alternation in LF/HF ratio which has no statistical significance. Diabetics with microalbuminuria when compared with controls showed a statistically significant (p-value=0.009) alternation in LF /HF ratio implying an autonomic imbalance.

Conclusions: This study shows there is significant vagal inhibition and autonomic imbalance in diabetic patients with microalbuminuria compared to controls. To ascertain the role of HRV as an early predictor of cardiovascular complications we propose to conduct study with a larger sample size in future.

Author Biographies

K. Deepalakshmi, Department of Physiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India

PHYSIOLOGY, ASSOCIATE PROFESSOR

S. Vijayabaskaran, Department of Physiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India

Physiology,Assistant professor

A. Murali, Department of Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India

PROFESSOR, INTERNAL MEDICINE

References

United Nations General Assembly. Resolution 64/265. Prevention and control of non-communicable diseases; 2010.

World Health Organization. Global burden of disease. 2004 update.

Bianchi S, Bigazzi R, Campese VM. Microalbuminuria in essential hypertension: significance, pathophysiology, and therapeutic implications. Am J Kidney Dis. 1999;34(6):973-95.

Schalkwijk CG, Stehouwer CD. Vascular complications in diabetes mellitus: the role of endothelial dysfunction. Clin Sci. 2005;109(2):143-59.

Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B, et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA. 2001;286:421-6.

Gottsater A, Ahlgren AR, Taimour S, Sundkvist G. Decreased heart rate variability may predict the progression of carotid atherosclerosis in type 2 diabetes. Clin Auton Res. 2006;16:228-34.

Vinik AI, Maser RE, Ziegler D. Neuropathy: the crystal ball for cardiovascular disease? Diabetes Care. 2010;33:1688-90.

Zandbergen AA, Vogt L, de Zeeuw D, Lamberts SW, Ouwendijk RJ, Baggen MG, et al. Change in albuminuria is predictive of cardiovascular outcome in normotensive patients with T2DM and microalbuminuria. Diabetes Care. 2007;30(12):3119-21.

Boysen A, Lewin MA, Hecker W, Leichter HE, Uhlemann F. Autonomic function testing in children and adolescents with diabetes mellitus. Pediatr Diab. 2007;8(5):261-4.

de Zeeuw D, Parving HH, Henning RH. Microalbuminuria as an early marker for cardiovascular disease. J Am Soc Nephrol. 2006;17(8):2100-5.

Task Force of the European Society of Cardiology and North American Society of Pacing and Electrophysiology: Heart rate variability: standards of measurements, physiological interpretation and clinical use. Circulation. 1996;93:1043-65.

American Diabetes Association. Economic costs of diabetes in the US in 2002. Diabetes Care. 2003;26(3):917-32.

Mirza M, Lakshmi ANR. A comparative study of heart rate variability in diabetic subjects and normal subjects. Int J Biomed Adv Res. 2012;03(08):640-4.

Faulkner MS, Quinn L, Rimmer JH, and Rich BH. Cardiovascular endurance and heart rate variability in adolescents with Type 1 or Type 2 Diabetes. Biol Res Nurs. 2005;7(1):16-29.

Kudat H, Akkaya V, Sozen AB, Salman S, Demirel S, Ozcan M, et al. Heart rate variability in diabetes patient. J Int Med Res. 2006;34:291-6.

Carnethon MR, Liao D, Evans GW, Cascio WE, Chamless LE, Heiss G. Correlates of the shift in heart rate variability with an active postural change in a healthy population sample: the atherosclerosis risk in communities study. Am Heart J. 2002;143(5):808-13.

Colhoun HM, Francis DP, Rubens MB, Underwood SR, Fuller JH. The association of heart-rate variability with cardiovascular risk factors and coronary artery calcification: a study in type 1 diabetic patients and the general population. Diabetes Care. 2001;24(6):1108-14.

Earle KA, Mishra M, Morocutti A, Barnes D, Stephens E, Chambers J, et al. Microalbuminuria as a marker of silent myocardial ischaemia in IDDM patients. Diabetologia. 1996;39:854-6.

Weir MR. Microalbuminuria and cardiovascular disease. Clin J Am Soc Nephrol. 2007;2(3):581-90.

Colberg SR, Swain DP, Vinik AI. Use of heart rate reserve and rating of perceived exertion to prescribe exercise intensity in diabetic autonomic neuropathy. Diabetes care. 2003;26(4):986-90.

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Published

2017-05-23

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Original Research Articles