Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Mar 15, 2015; 6(2): 245-258
Published online Mar 15, 2015. doi: 10.4239/wjd.v6.i2.245
Diabetic cardiac autonomic neuropathy: Do we have any treatment perspectives?
Victoria A Serhiyenko, Alexandr A Serhiyenko
Victoria A Serhiyenko, Alexandr A Serhiyenko, Department of Endocrinology, National Medical University named after Danylo Galytski, 79017 Lviv, Ukraine
Author contributions: Serhiyenko VA performed the literature search and wrote first draft; Serhiyenko AA provided expert opinion and reviewed the paper.
Conflict-of-interest: The authors have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Victoria A Serhiyenko, Department of Endocrinology, National Medical University named after Danylo Galytski, 69 Pekarska Str., 79017 Lviv, Ukraine. serhiyenko@inbox.ru
Telephone: +380-322-769496
Received: August 28, 2014
Peer-review started: August 30, 2014
First decision: September 28, 2014
Revised: October 24, 2014
Accepted: December 29, 2014
Article in press: December 30, 2014
Published online: March 15, 2015
Processing time: 202 Days and 21.8 Hours
Abstract

Cardiac autonomic neuropathy (CAN) is a serious and common complication of diabetes mellitus (DM). Despite its relationship to an increased risk of cardiovascular mortality and its association with multiple symptoms and impairments, the significance of CAN has not been fully appreciated. CAN among DM patients is characterized review the latest evidence and own data regarding the treatment and the treatment perspectives for diabetic CAN. Lifestyle modification, intensive glycemic control might prevent development or progression of CAN. Pathogenetic treatment of CAN includes: balanced diet and physical activity; optimization of glycemic control; treatment of dyslipoproteinemia; correction of metabolic abnormalities in myocardium; prevention and treatment of thrombosis; use of aldose reductase inhibitors; dihomo-γ-linolenic acid (DGLA), acetyl-L-carnitine, antioxidants, first of all α-lipoic acid (α-LA), use of long-chain ω-3 and ω-6 polyunsaturated fatty acids (ω-3 and ω-6 PUFAs), vasodilators, fat-soluble vitamin B1, aminoguanidine; substitutive therapy of growth factors, in severe cases-treatment of orthostatic hypotension. The promising methods include research and use of tools that increase blood flow through the vasa vasorum, including prostacyclin analogues, thromboxane A2 blockers and drugs that contribute into strengthening and/or normalization of Na+, K+-ATPase (phosphodiesterase inhibitor), α-LA, DGLA, ω-3 PUFAs, and the simultaneous prescription of α-LA, ω-3 PUFA and DGLA.

Keywords: Diabetes mellitus; Cardiac autonomic neuropathy; Postural hypotension; treatment

Core tip: Cardiac autonomic neuropathy (CAN) is a serious complication of diabetes mellitus, that is strongly associated with increased risk of cardiovascular mortality. CAN manifests in a spectrum of things, ranging from resting tachycardia and fixed heard rate to development of “silent” myocardial infarction. Although it is common complication, the significance of CAN has not been fully appreciated and there are no unified treatment algorithms for today. In this review we have analyzed the effectiveness of lifestyle modification, prescription of α-lipoic acid, aldose reductase inhibitors; γ-linoleic acid, acetyl-L-carnitine, antioxidants, long-chain ω-3 polyunsaturated fatty acids, vasodilators, vitamin B1 and some other substances.