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[Cardiac autonomous neuropathy and metabolic syndrome in patients with type 2 diabetes mellitus].

Cardiac autonomous neuropathy (CAN) is a rare complication of diabetes mellitus (DM) that impairs the patient"s quality of life and prognosis. Despite evidence if common pathogenetic mechanism of metabolic syndrome (MS) and autonomous dysfunction, the relationship between CAN and MS in type 2 DM remains poorly known. We examined 157 patients with DM to study manifestations of CAN depending on the presence of MS components. MS was diagnosed using WHO criteria and CAN based on two or more pathologic results in Ewing"s cardiovascular tests (deep respiration test, Valsalva test, orthostatic test with estimation of HR and AP). The patients were allocated to 4 groups to evaluate clinical symptoms of CAN, cardiac rhythm variability and daily AP profile. Group 1 comprised 14 patients without CAN presenting with not more than one component of MS, group 2 16 patients without CAN with 2-3 components of MS, group 3 108 patients with CAN and not more than one component of MS, group 4 108 patients with CAN and 2-3 with component of MS. Overall CAN prevalence was 80.9%. The occurrence of CAN positively correlated with peripheral polyneuropathy, arterial hypertension, severity of DM, AP, and the number of MS components. The presence of CAN and/or 2 and more MS components associated with lowered index of cardiac rhythm variability (LF/HF) indicative of disturbed sympatovagal balance. The daily AP profile in patients with CAN and 2 or more MS components was characterized by anomalous nocturnal drop. Combination of CAN with 2 or more MS components was associated with the most unfavourable night time AP profile.