European Heart Journal Advance Access published online on March 19, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm018
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Association between cardiac autonomic dysfunction and inflammation in type 1 diabetic patients: effect of beta-blockade
1 Istituto di cardiologia, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Roma, Italy
2 Diabetes Care Unit, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Roma, Italy
Received 25 September 2006; revised 7 February 2007; accepted 15 February 2007.
* Corresponding author. Tel: +39 06 3015 4187; fax: +39 06 3055535. E-mail address: g.a.lanza{at}inwind.it
Aims: To assess the relationship between cardiac autonomic dysfunction and inflammation in patients with type 1 diabetes and whether beta-blocker therapy might improve both abnormalities in these patients.
Methods and results: We studied 49 patients with type 1 diabetes (age 50.5 ± 11 years, 33 men). Serum levels of high-sensitivity C-reactive protein, as a marker of inflammation, and frequency-domain heart rate variability (HRV) on 24 h Holter monitoring, as a measure of cardiac autonomic function, were assessed in all patients. Twenty-one patients with depressed HRV were subsequently randomized to receive atenolol (50 mg daily) or no-beta-blockade. HRV and C-reactive protein were re-assessed after 3–4 weeks from randomization. An inverse correlation was found between C-reactive protein levels and HRV parameters, with the highest r coefficient shown with low-frequency (LF) power (r = –0.38; P = 0.007). Furthermore, C-reactive protein serum levels were significantly higher in patients with bottom quartile values of LF power compared with patients with values in the three top quartiles (4.64 ± 2.8 vs.1.79 ± 1.6 mg/L, respectively; P = 0.003), also after adjustment for potential confounding variables (P = 0.013). HRV parameters improved significantly in patients treated with atenolol, but not in the no-atenolol group. Furthermore, C-reactive protein levels decreased in the beta-blockade group, but not in the no-beta-blockade group (P = 0.04 for changes between groups).
Conclusion: In type 1 diabetic patients, serum C-reactive protein levels are significantly associated with depressed HRV; the favourable effects of beta-blockade on both HRV parameters and C-reactive protein serum levels suggest that autonomic nervous system may have significant modulator effects on inflammation.
Key Words: Type 1 diabetes • Heart rate variability • C-reactive protein
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