Cardiovascular autonomic neuropathy (CAN) is a severely debilitating yet underdiagnosed condition in patients with diabetes. The prevalence can range from 2.5% (based on the primary prevention cohort in the Diabetes Control and Complications Trial) to as high as 90% of patients with type 1 diabetes. Clinical manifestations range from orthostasis to myocardial infarction. The diagnosis is made using multiple autonomic function tests to assess both sympathetic and parasympathetic function. The pathophysiology of CAN is complex, likely multifactorial, and not completely understood. Treatment is limited to symptomatic control of orthostatic hypotension, which is a late complication, and current strategies to reverse CAN are limited. This review explores the epidemiology, pathophysiology, clinical manifestations, diagnosis, and complications of CAN as well as current treatment options.
Keywords: CARTs; DCCT study; EDIC study; EURODIAB study; Toronto Consensus Panel; Valsalva; cardiac autonomic neuropathy; cardiac autonomic reflex tests; cardiovagal; diabetes; diabetic neuropathy; exercise intolerance; glycosylation; heart rate variability; hyperglycemia; microvascular complications; orthostatic hypotension; parasympathetic; perioperative mortality; reactive oxygen species; resting tachycardia; silent ischemia; sympathetic.