Early commitment of cardiovascular autonomic modulation in Brazilian patients with congenital generalized lipodystrophy

• Autor(a) principal: Ponte, Clarisse Mourão Melo
• Data de Publicação: 2018
• Outros Autores: Fernandes, Virgínia Oliveira, Gurgel, Maria Helane Costa, Vasconcelos, Izabella Tamira Galdino Farias, Karbage, Lia Beatriz de Azevedo Souza, Liberato, Christiane Bezerra Rocha, Negrato, Carlos Antônio, Gomes, Marília de Brito, Montenegro, Ana Paula Dias Rangel, Montenegro Júnior, Renan Magalhães
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da Universidade Federal do Ceará (UFC)
• Texto Completo: http://www.repositorio.ufc.br/handle/riufc/30476
• topic: Lipodistrofia; Lipodystrophy; Diabetes Mellitus; Leptina

Background: Metabolic abnormalities in congenital generalized lipodystrophy (CGL) are associated with microvascular complications. However, the evaluation of different types of neuropathy in these patients, including the commitment of cardiovascular autonomic modulation, is scarce. The objective of the present study was to determine the prevalence of cardiovascular autonomic neuropathy (CAN) in patients with CGL compared with individuals with type 1 diabetes and healthy subjects. Methods: Ten patients with CGL, 20 patients with type 1 diabetes and 20 healthy subjects were included in the study. Controls were paired 1:2 for age, gender, BMI and pubertal stage. Heart rate variability (HRV) was analyzed using cardiovascular autonomic reflex tests, including postural hypotension test, Valsalva (VAL), respiratory (E/I) and orthostatic (30/15) coefficients, and spectral analysis of the HRV, determining very low (VLF), low (LF) and high (HF) frequencies components. The diagnosis of CAN was defined as the presence of at least two altered tests. Results: CAN was detected in 40% of the CGL patients, 5% in typ e 1 diabetes patients an d was absent in healthy individuals ( p < 0.05). We observed a significant reduction in the E/I, VLF, LF and HF in CGL cases vs. type 1 diabetes and healthy individuals and lower levels of 30/15 and VAL in CGL vs. he althy individuals. A significant positive correlation was observed between leptin and 30/15 coefficient ( r = 0.396; p = 0.036) after adjusting for insul in resistance and triglycerides. Autonomic cardiovascular tests were associated with HbA1c, HOMA-IR, triglycerides and albumin/creatinine ratioinCGLcases. Conclusions: We observed a high prevalence of CAN in young patients with CGL, suggesting that insulin resistance, hypertriglyceridemia and hypoleptinemia, may have been involved in early CAN development. Additional studies are needed to evaluate the role of lep tinemia in the physiopathogenesis of the condition