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Aims: We assessed whether cardiovascular autonomic neuropathy (CAN), as assessed by heart rate variability (HRV), is associated with an increased risk of heart failure (HF) in 6347 patients with type 2 diabetes (T2D) enrolled in the DEVOTE trial with HRV data available.

Methods: DEVOTE was a randomized, double-blind trial comparing the impact of insulin degludec to glargine 100 units/mL on cardiovascular outcomes. Indices of HRV were derived from 10-sec standard electrocardiogram at enrollment, with values below the 5th percentile of the cohort defined as abnormal. Time to first hospitalization due to HF was analyzed using Kaplan-Meier survival curves and the log-rank test.

Results: A total of 369 (5.8%) had CAN. Participants with and without CAN had significant different [mean(standard deviation)] age [63.4(7.3) and 64.9(7.3) years], A1C [8.9(1.9) and 8.4(1.6)%], body mass index [33.0(7.4) and 33.6(6.8) kg/m2] and number of subjects from minority ethnicity [19.5 and 15.2%], respectively (P<0.05). In adjusted analyses, CAN at baseline was associated with a significantly higher risk of hospitalization for HF [hazard ratio=1.47 (95% confidence interval:1.04-2.06); P=0.028] over follow-up period (Figure).

Conclusion: These data suggest that CAN may be used for risk stratifying in patients with T2D at risk for developing symptomatic HF.


R. Pop-busui: Advisory Panel; Self; Novo Nordisk, Consultant; Self; Averitas Pharma, Bayer Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Nevro Corp., Regenacy. L. Ang: None. S. Hayek: Advisory Panel; Self; Walden Biosciences. K. R. Mizokami-stout: None. E. Parvaresh rizi: Employee; Self; Novo Nordisk. I. Lingvay: Advisory Panel; Self; Bayer Healthcare Pharmaceuticals Inc., Lilly Diabetes, Consultant; Self; TARGET PharmaSolutions, Other Relationship; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk, Pfizer Inc., Zealand Pharma A/S, Research Support; Self; Mylan N. V., Sanofi. On behalf of the devote study group: n/a.


Novo Nordisk

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