{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T13:22:19Z","timestamp":1792761739110,"version":"4.5.0"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,10,17]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">There is a paucity of large\u2010scale epidemiological studies on the link between cardiac autonomic neuropathy (CAN) and the risk of silent myocardial infarction (SMI) in type 2 diabetes. We evaluated the association between CAN and the risk of SMI in a large sample of adults with type 2 diabetes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">Participants with type 2 diabetes from the ACCORD (Action to Control Cardiovascular Risk in Diabetes) study without atherosclerotic cardiovascular disease at baseline were included. CAN was ascertained using heart rate variability indices calculated from 10\u2010s resting electrocardiograms. The heart rate variability indices included standard deviation of all normal\u2010to\u2010normal R\u2010R intervals and root mean square of successive differences between normal\u2010to\u2010normal R\u2010R intervals. CAN was defined as both the standard deviation of all normal\u2010to\u2010normal R\u2010R intervals and root mean square of successive differences between normal\u2010to\u2010normal R\u2010R intervals less than the fifth percentile of the general population. We used Cox proportional hazards regression to generate hazard ratios (HRs) for incident SMI in relation to CAN measures. Among 4842 participants (mean age, 62.5\u2009years; 46.6% women; 60.2% White), there were 73 incident SMI cases over a median follow\u2010up of 4.9\u2009years (incidence rate 3.1 out of 1000 person\u2010years [95% CI, 2.5\u20133.9]). After adjusting for confounders, low heart rate variability was associated with a higher risk of SMI (HR, 1.67 [95% CI, 1.02\u20132.72] and HR, 1.56 [95% CI, 0.94\u20132.58] for low standard deviation of all normal\u2010to\u2010normal R\u2010R intervals and root mean square of successive differences between normal\u2010to\u2010normal R\u2010R intervals, respectively). Participants with CAN had a 1.9\u2010fold greater risk of SMI (HR, 1.91 [95% CI, 1.14\u20133.20]).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">In a large cohort of adults with type 2 diabetes, CAN was significantly associated with an increased risk of incident SMI.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.029814","type":"journal-article","created":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T10:10:33Z","timestamp":1697191833000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":28,"title":["Cardiac Autonomic Dysfunction and Risk of Silent Myocardial Infarction Among Adults With Type 2 Diabetes"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5470-8296","authenticated-orcid":false,"given":"Arnaud D.","family":"Kaze","sequence":"first","affiliation":[{"name":"Department of Medicine University of Maryland Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3192-8093","authenticated-orcid":false,"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Ahmanson\u2010UCLA Cardiomyopathy Center Ronald Reagan UCLA Medical Center Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8460-1617","authenticated-orcid":false,"given":"Justin B.","family":"Echouffo\u2010Tcheugui","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes &amp; 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