Cardiovascular Autonomic Neuropathy

Diabetic neuropathies are the most prevalent chronic complications of diabetes, present with diverse clinical manifestations, and promote high morbidity and mortality, low quality of life, and high health care costs. Among the various forms of diabetic neuropathy, distal symmetric polyneuropathy and diabetic autonomic neuropathies, particularly cardiovascular autonomic neuropathy (CAN), are by far the most studied. Although frequently overlooked in clinical practice due to its characteristic initial very subtle presentation, CAN is quite prevalent in individuals with both type 1 and type 2 diabetes. In addition, high prevalence rates for CAN were reported in several cohorts of individuals with prediabetes/metabolic syndrome and obesity, as well as in youth. Evidence from several large cohorts shows that CAN is an independent predictor of all-cause and cardiovascular mortality as well as of cardiovascular disease risk, including more recently heart failure. Thus, screening for symptoms and signs of CAN is critical in clinical practice as it may be used for risk stratification and to enable early interventions. Although disease modifying therapies for diabetic neuropathy in general including CAN are still lacking, several symptomatic treatment options exist for some forms of CAN.