DANVILLE, VA — What is the association between cardiac autonomic neuropathy (CAN) with incident stroke among diabetes mellitus patients?

A new study involving LifePoint Health, as well as the VA Boston Healthcare System and medical institutions, evaluated the association in a large sample of adults with Type 2 diabetes.

Included in the study published in the European Stroke Journal were participants with Type 2 diabetes from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study without atherosclerotic cardiovascular disease at baseline. The 3,493 patients had a mean age of 62.2 years and were 44.5% women and 62.9% white.1

For the study, CAN was assessed at baseline by researchers’ calculation of heart rate variability (HRV) indices and QT index (QTI) from 10-s resting electrocardiograms; HRV was determined using standard deviation of all normal-to-normal R-Rs intervals (SDNN) and root-mean-square of successive differences between normal-to-normal R-R intervals (rMSSD). Several composite measures were used to define CAN, including SDNN, QTI, resting heart rate and peripheral neuropathy.

The researchers report that, over a median follow-up of five years, 50 stroke cases occurred (incidence rate 3.0/1000 person-years [95% CI 2.2-3.9]). After adjusting for confounders, low HRV was found to be associated with a higher risk of stroke (HR of 2.20 [95% CI 1.23-3.93] and 1.88 [95% CI 1.04-3.41] for low SDNN and rMSSD, respectively). In fact, the study indicated that participants with CAN (defined as the lowest quartile of SDNN and highest quartiles of QTI and heart rate) had a 5.7-fold greater risk of stroke (HR 5.70, 95% CI 2.49-13.08).

“CAN was independently associated with an increased risk of incident stroke in a large cohort of adults with Type 2 diabetes,” the authors concluded.


  1. Kaze AD, Yuyun MF, Fonarow GC, Echouffo-Tcheugui JB. Cardiac autonomic dysfunction and risk of incident stroke among adults with type 2 diabetes. Eur Stroke J. 2023 Mar;8(1):275-282. doi: 10.1177/23969873221127108. Epub 2022 Nov 1. PMID: 37021204; PMCID: PMC10069192.