Published: 2019-03-27

Prevalence of cardiac autonomic dysfunction in patients with metabolic syndrome: a cross-sectional, observational study

Akash C. Lohakare, Pawan Mehta, Shuchi Singh


Background: Cardiovascular autonomic neuropathy (CAN) is a distinguished disorder associated with diabetes mellitus and metabolic syndrome. The pathogenesis of CAN in patients with metabolic syndrome still remains unclear. This study was undertaken to assess the prevalence of cardiac autonomic dysfunction in patients with metabolic syndrome and to correlate different parameters of metabolic syndrome with cardiac autonomic dysfunction.

Methods: In this cross-sectional observational study, total 100 consecutive cases meeting the inclusion criteria and attending the Department of Medicine in Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi were enrolled. 50 subjects who satisfied the IDF criteria of metabolic syndrome were taken as cases and remaining 50 subjects (age and gender matched) who did not satisfy the IDF criteria were taken as controls. Comparison of categorical variables was made using chi-square or Fisher’s exact test. P-value <0.05 was considered as statistically significant.

Results: Majority of study population (i.e., 42%) belonged to the age group of 41-50 years. Overall prevalence of cardiac autonomic dysfunction (CAD) was 25%. Prevalence of CAD among cases and controls was 38% and 12%, respectively. Overall distribution of various parameters like waist circumference, fasting blood glucose, blood pressure, HDL-C and serum triglycerides was assessed in all subjects with respect to CAD. Statistically significant association of these parameters was seen with CAD (p-value ≤0.01).

Conclusions: In this study, strong association was found between CAD and central obesity, impaired fasting glucose, high blood pressure and dyslipidemia. Thus, the metabolic disorders are good predictors of CAD.


Cardiac autonomic dysfunction, Diabetes mellitus, Metabolic syndrome

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International Diabetes Federation. IDF Diabetes Atlas, 8th Edition, 2017. Available at: Accessed on 15 December 2018.

Huang P. A comprehensive definition for metabolic syndrome. Dis Models Mech. 2009;2:231-7.

Deepa M, Farooq S, Datta M, Deepa R, Mohan V. Prevalence of metabolic syndrome using WHO, ATP III and IDF definition in Asian Indians: the Chennai urban rural epidemiology study (CURES-34). Diabetes Metab Res Rev. 2007;23:127-34.

Adams RJ, Appleton S, Wilson DH, Taylor AW, Dal Grande E, Chittleborough C, et al. Population comparison of two clinical approaches to the metabolic syndrome. Diabetes Care. 2005;28:2777-9.

O'Neill S., O'Driscoll L. Metabolic syndrome: a closer look at the growing epidemic and its associated pathologies. Obes. Rev. 2015;16(1):1-12.

Ravikiran M, Bhansali A, Ravikumar P, Bhansali S, Dutta P, Thakur JS, et al. Prevalence and risk factors of metabolic syndrome among Asian Indians: a community survey. Diab Res Clin Pract. 2010;89(2):181-8.

Sawant A, Mankeshwar R, Shah S, Raghavan R, Dhongde G, Raje H, et al. Prevalence of metabolic syndrome in urban India. Cholesterol. 2011;2011: 920-83.

Fisher VL, Tahrani AA. Cardiac autonomic neuropathy in patients with diabetes mellitus: current perspectives. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2017;10:419-34.

McNeill AM, Rosamond WD, Girman CJ, Golden SH, Schmidt MI, East HE, et al. Metabolic syndrome and 11-year risk of incident cardiovascular disease in atherosclerosis risk in community study. Diabetes care. 2005;28:385-90.

Boyko EJ, de Courten M, Zimmet PZ, Chitson P, Tuomilehto J, Alberti KG, et al. Features of metabolic syndrome predict higher risk of diabetes and impaired glucose tolerance. Diabetes care. 2000;23:1242-8.

Lorenzo C, Okoloise M, Williams K, Stern MP, Haffner SM. The metabolic syndrome as predictor of type 2 diabetes: Diabets Care. 2003;26:3153-9.

Wang JJ, Qiao Q, Miettinen ME, Lappalainen J, Hu G, Tuomilehto J. The metabolic syndrome defined by factor analysis and incident type 2 diabetes with high post prandial glucose. Diabetes Care. 2004;27:2429-37.

Ziegler D, Zentai C, Perz S, Rathmann W, Haastert B, Meisinger C, et al. Diminished heart rate variability (HRV) and prolonged QTc interval, but not increased QT dispersion (QTD) are predicators of mortality in the diabetic population. Diabetes. 2004;53(suppl 2):A57.

Serhiyenko VA, Serhiyenko AA. Cardiac autonomic neuropathy: Risk factors, diagnosis and treatment. World J Diabetes. 2018;9(1):1-24.

Ma Y, Tseng PH, Ahn A, Wu MS, Ho YL, Chen MF, et al. Cardiac autonomic alteration and metabolic syndrome: an ambulatory ECG-based study in a general population. Scientific reports. 2017;7(44):363.

Vinik AI, Casellini C, Parson HK, Colberg SR, Nevoret ML. Cardiac Autonomic Neuropathy in Diabetes: A Predictor of Cardiometabolic Events. Frontiers Neurosci. 2018;12:591.

Laitinen T, Lindström J, Eriksson J, Ilanne‐Parikka P, Aunola S, Keinänen‐Kiukaanniemi S, et al. Cardiovascular autonomic dysfunction is associated with central obesity in persons with impaired glucose tolerance. Diabet Med. 2011;28:699-704.

Nishnianidze MA, Kurashvili RB, Khelashvili MG, Tsutskiridze LR, Bekaia MG. Cardiac autonomic neuropathy in relation to some components of metabolic syndrome in newly diagnosed type 2 diabetic patients. Endocrine Abstracts. 2007;11:415.

Garruti G, Giampetruzzi F, Vita MG, Pellegrini F, Lagioia P, Stefanelli G, et al. Links between metabolic syndrome and cardiovascular autonomic dysfunction. Experimental Diab Res. 2012 Mar 15;2012.

Zhu L, Zhao X, Zeng P, Zhu J, Yang S, Liu A, Song Y, et al. Study on autonomic dysfunction and metabolic syndrome in Chinese patients. J Diabetes Investig. 2016;7(6):901-7.

Balcioğlu AS, Akinci S, Çiçek D, Eldem HO, Çoner A, Bal UA, et al. Which is responsible for cardiac autonomic dysfunction in non-diabetic patients with metabolic syndrome: Prediabetes or the syndrome itself?. Diabetes and Metabolic Syndrome: Clinical Research and Reviews. 2016;10(1):S13-20.

Wu JS, Lu FH, Yang YC, Lin TS, Chen JJ, Wu CH, et al. Epidemiological study on the effect of pre-hypertension and family history of hypertension on cardiac autonomic function. J Ame Coll Cardiol. 2008 May 13;51(19):1896-901.

Poliakova N, Després JP, Bergeron J, Alméras N, Tremblay A, Poirier P. Influence of obesity indices, metabolic parameters and age on cardiac autonomic function in abdominally obese men. Metabolism. 2012 Sep 1;61(9):1270-9.

Thiyagarajan R, Subramanian SK, Sampath N, Trakroo M, Pal P, Bobby Z, et al. Association between cardiac autonomic function, oxidative stress and inflammatory response in impaired fasting glucose subjects: cross-sectional study. Plos one. 2012;7(7):e41889.

Mancia G, Grassi G. The autonomic nervous system and hypertension. Circulation Research. 2014 May 23;114(11):1804-14.

Vrijkotte TG, van den Born BJ, Hoekstra CM, Gademan MG, van Eijsden M, de Rooij SR, et al. Cardiac autonomic nervous system activation and metabolic profile in young children: the ABCD study. PloS one. 2015;10(9):e0138302.

Kumar MS, Singh A, Jaryal AK, Ranjan P, Deepak KK, Sharma S, et al. Cardiovascular autonomic dysfunction in patients of nonalcoholic fatty liver disease. Int J Hepatol. 2016; 2016.

Soares‐Miranda L, Sandercock G, Vale S, Santos R, Abreu S, Moreira C, et al. Metabolic syndrome, physical activity and cardiac autonomic function. Diab/Meta Res Rev. 2012;28(4):363-9.