Assessment of Autonomic Cardiovascular Neuropathy and Peripheral Artery Disease in Patients with Type 2 Diabetes Mellitus in Support of the Risk Stratification Strategy and Referral to Complementary Exams in Clinical Practice.
Type 2 diabetes mellitus is a disorder of glucose metabolism, a clinical, progressive syndrome whose main mechanism is insulin resistance. For the next two decades, there is a prospect that almost 700 million individuals will be affected by DM2. Patients with DM2 have up to 3x higher cardiovascular mortality compared to healthy individuals. And, due to its pathophysiological mechanisms, DM2 is a high risk factor for the occurrence of peripheral arterial disease (PAD) and autonomic cardiovascular neuropathy (ACN). PAD is an independent risk factor for major cardiovascular events, including ischemic stroke, myocardial infarctions, and cardiovascular death; and ACN, characterized by damage to the fibers of the autonomic nerves that innervate the heart and blood vessels, leading to abnormalities in heart rate and vascular dynamics, is associated with myocardial ischemia, coronary artery disease, QT segment prolongation, and to strokes. To face this reality, it is possible to use non-invasive, clinically reproducible strategies for screening and selecting patients with a greater indication of being submitted to specialized evaluation, in order to refer them for possible complementary tests and adequate the most indicated therapeutic strategies. Among these strategies, the Ankle Brachial Index and the Ewing Test can be highlighted, which assess PAD and ACN, respectively. Therefore, evaluating the relationship between these two conditions can help in patient risk stratification and for more effective prevention and treatment strategies.
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