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World J Diabetes. Jun 15, 2021; 12(6): 855-867
Published online Jun 15, 2021. doi: 10.4239/wjd.v12.i6.855
Cardiovascular autonomic neuropathy in diabetes: Pathophysiology, clinical assessment and implications
Alice Duque, Mauro Felippe Felix Mediano, Andrea De Lorenzo, Luiz Fernando Rodrigues Jr
Alice Duque, Mauro Felippe Felix Mediano, Andrea De Lorenzo, Luiz Fernando Rodrigues Jr, Education and Research Department, Instituto Nacional de Cardiologia, Rio de Janeiro 22240006, RJ, Brazil
Mauro Felippe Felix Mediano, Laboratory of Clinical Research on Chagas Disease, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040360, RJ, Brazil
Luiz Fernando Rodrigues Jr, Department of Physiological Sciences, Biomedical Institute, Federal University of the State of Rio de Janeiro, Rio de Janeiro 22240006, RJ, Brazil
Author contributions: Duque A wrote the manuscript; Mediano MFF and Rodrigues Jr LF wrote and revised of manuscript; De Lorenzo A contributed article conception and writing; all authors have read and approved the final manuscript.
Conflict-of-interest statement: De Lorenzo A is an employee of the National Institute of Cardiology. Mediano MFF is an employee of Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation. Rodrigues Jr LF is an employee of the National Institute of Cardiology and of the Federal University of the State of Rio de Janeiro.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Andrea De Lorenzo, PhD, Professor, Education and Research Department, Instituto Nacional de Cardiologia, Rua das Laranjeiras 374, Rio de Janeiro 22240006, RJ, Brazil. andlorenzo@hotmail.com
Received: February 28, 2021
Peer-review started: February 28, 2021
First decision: March 30, 2021
Revised: April 5, 2021
Accepted: May 20, 2021
Article in press: May 20, 2021
Published online: June 15, 2021
Processing time: 95 Days and 17 Hours
Core Tip

Core Tip: Cardiovascular autonomic neuropathy (CAN) is an important risk factor for cardiovascular events. However, CAN may be subclinical for several years, worsening its potential contribution to increased mortality due to late diagnosis. Even during the subclinical stage, CAN could be detected through reduction in heart rate variability, a non-invasive test. Therefore, considering that diabetes mellitus is a global epidemic and that diabetic neuropathy is the most common chronic complication of diabetes, the early identification and treatment of CAN could be a key point to mitigate the morbidity and mortality impact from this long-lasting condition.