{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:59:51Z","timestamp":1792789191230,"version":"4.5.0"},"reference-count":154,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T00:00:00Z","timestamp":1743206400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["Fo 315\/5-1"],"award-info":[{"award-number":["Fo 315\/5-1"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Forschung hilft","award":["Fo 315\/5-1"],"award-info":[{"award-number":["Fo 315\/5-1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biomolecules"],"abstract":"<jats:p>Patients with type 2 diabetes mellitus (T2DM) predominantly experience mortality due to cardiovascular diseases (CVD), particularly in low- and middle-income nations. Among these, heart failure (HF) is the most severe cardiovascular complication in terms of prognosis and management. Despite advancements in individualized glycemic control and cardiovascular risk management, including the development of novel glucose- and lipid-lowering agents, the prevalence of HF in T2DM patients remains persistently high. This indicates that factors beyond hyperglycemia significantly contribute to the heightened risk of HF associated with T2DM. This review examines critical factors influencing CVD risk in T2DM, particularly the roles of reduced heart rate variability (HRV), a marker of autonomic dysfunction, and chronic inflammation, both of which play pivotal roles in HF pathogenesis. Recent evidence highlights the potential of vagus nerve activation to modulate these risk factors, underscoring its capacity to reduce T2DM-related cardiovascular complications. Specifically, we discuss the therapeutic promise of transcutaneous auricular vagus nerve stimulation (taVNS) as a non-invasive intervention to enhance vagal tone, decrease systemic inflammation, and improve cardiovascular outcomes in T2DM. By addressing the interplay among HRV, microvascular disease, and inflammation, this review provides a comprehensive perspective on the potential utility of taVNS in managing HF in T2DM.<\/jats:p>","DOI":"10.3390\/biom15040499","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T05:21:04Z","timestamp":1743398464000},"page":"499","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Heart Rate Variability, Microvascular Dysfunction, and Inflammation: Exploring the Potential of taVNS in Managing Heart Failure in Type 2 Diabetes Mellitus"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1222-8729","authenticated-orcid":false,"given":"Serge C.","family":"Thal","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Helios University Hospital, Witten\/Herdecke University, 42283 Wuppertal, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6953-9771","authenticated-orcid":false,"given":"Sergey","family":"Shityakov","sequence":"additional","affiliation":[{"name":"Laboratory of Chemoinformatics, Infochemistry Scientific Center, ITMO University, 197101 Saint-Petersburg, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2127-4548","authenticated-orcid":false,"given":"Ellaine","family":"Salvador","sequence":"additional","affiliation":[{"name":"Section Experimental Neurosurgery, Department of Neurosurgery, University Hospital W\u00fcrzburg, 97080 W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3878-247X","authenticated-orcid":false,"given":"Carola Y.","family":"F\u00f6rster","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, Section Cerebrovascular Sciences and Neuromodulation, University Hospital W\u00fcrzburg, 97080 W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S37","DOI":"10.1007\/s00508-015-0931-3","article-title":"Diabetes mellitus: Definition, classification and diagnosis","volume":"128","author":"Roden","year":"2016","journal-title":"Wien. Klin. Wochenschr."},{"key":"ref_2","first-page":"394","article-title":"Common and rare forms of diabetes mellitus: Towards a continuum of diabetes subtypes. Nature reviews","volume":"12","author":"Flannick","year":"2016","journal-title":"Endocrinology"},{"key":"ref_3","first-page":"83","article-title":"Insulin dependent diabetes mellitus as an autoimmune disease","volume":"2","author":"Monos","year":"1988","journal-title":"In Vivo"},{"key":"ref_4","unstructured":"Sapra, A., and Bhandari, P. (2021). Diabetes Mellitus. StatPearls, StatPearls Publishing."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1186\/s12933-022-01516-6","article-title":"Cardiovascular disease in type 2 diabetes mellitus: Progress toward personalized management","volume":"21","author":"Ma","year":"2022","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1186\/s12933-018-0728-6","article-title":"Prevalence of cardiovascular disease in type 2 diabetes: A systematic literature review of scientific evidence from across the world in 2007\u20132017","volume":"17","author":"Einarson","year":"2018","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Sorski, L., and Gidron, Y. (2023). The Vagal Nerve, Inflammation, and Diabetes-A Holy Triangle. Cells, 12.","DOI":"10.3390\/cells12121632"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.ijcard.2017.07.081","article-title":"Incidence of cardiovascular events and vascular interventions in patients with type 2 diabetes","volume":"248","author":"Engelen","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.2337\/dci22-0014","article-title":"Heart Failure: An Underappreciated Complication of Diabetes. A Consensus Report of the American Diabetes Association","volume":"45","author":"Januzzi","year":"2022","journal-title":"Diabetes Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1161\/CIRCRESAHA.120.315913","article-title":"Basic Mechanisms of Diabetic Heart Disease","volume":"126","author":"Ritchie","year":"2020","journal-title":"Circ. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/0002-9149(72)90595-4","article-title":"New type of cardiomyopathy associated with diabetic glomerulosclerosis","volume":"30","author":"Rubler","year":"1972","journal-title":"Am. J. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.pcad.2019.03.003","article-title":"Diabetic cardiomyopathy\u2014A comprehensive updated review","volume":"62","author":"Murtaza","year":"2019","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41401-018-0042-6","article-title":"Vascular endothelial dysfunction, a major mediator in diabetic cardiomyopathy","volume":"40","author":"Knapp","year":"2019","journal-title":"Acta Pharmacol. Sin."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1097\/HJH.0b013e3283331169","article-title":"Diabetes and incident heart failure in hypertensive and normotensive participants of the Strong Heart Study","volume":"28","author":"Devereux","year":"2010","journal-title":"J. Hypertens."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Holscher, M.E., Bode, C., and Bugger, H. (2016). Diabetic Cardiomyopathy: Does the Type of Diabetes Matter?. Int. J. Mol. Sci., 17.","DOI":"10.3390\/ijms17122136"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Mohan, M., Dihoum, A., Mordi, I.R., Choy, A.M., Rena, G., and Lang, C.C. (2021). Left Ventricular Hypertrophy in Diabetic Cardiomyopathy: A Target for Intervention. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.746382"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1186\/s12933-022-01533-5","article-title":"Impact of type 2 diabetes mellitus on left ventricular deformation in non-ischemic dilated cardiomyopathy patients assessed by cardiac magnetic resonance imaging","volume":"21","author":"Shen","year":"2022","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e147","DOI":"10.1016\/j.jacc.2013.05.019","article-title":"2013 ACCF\/AHA guideline for the management of heart failure: A report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines","volume":"62","author":"Yancy","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3035","DOI":"10.1093\/eurheartj\/eht108","article-title":"ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD)","volume":"34","author":"Ryden","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1186\/s12933-024-02307-x","article-title":"Assessment of subclinical LV myocardial dysfunction in T2DM patients with diabetic peripheral neuropathy: A cardiovascular magnetic resonance study","volume":"23","author":"Li","year":"2024","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.cjca.2011.02.008","article-title":"Diastolic heart failure: Progress; treatment challenges, and prevention","volume":"27","author":"Wood","year":"2011","journal-title":"Can. J. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1016\/j.jacc.2006.07.033","article-title":"Diastolic dysfunction and diabetic cardiomyopathy: Evaluation by Doppler echocardiography","volume":"48","author":"Galderisi","year":"2006","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.jcmg.2016.02.033","article-title":"Association of Insulin Resistance and Glycemic Metabolic Abnormalities With LV Structure and Function in Middle Age: The CARDIA Study","volume":"10","author":"Kishi","year":"2017","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e002560","DOI":"10.1161\/CIRCHEARTFAILURE.115.002560","article-title":"Risk Related to Pre-Diabetes Mellitus and Diabetes Mellitus in Heart Failure With Reduced Ejection Fraction: Insights From Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial","volume":"9","author":"Kristensen","year":"2016","journal-title":"Circ. Heart Fail."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.cpcardiol.2017.05.001","article-title":"Pathophysiology and Prevention of Heart Disease in Diabetes Mellitus","volume":"43","author":"Oktay","year":"2018","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.visres.2017.05.009","article-title":"The inner blood-retinal barrier: Cellular basis and development","volume":"139","author":"Ramos","year":"2017","journal-title":"Vis. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/S0002-9149(00)01366-7","article-title":"Prevalence of diastolic dysfunction in normotensive, asymptomatic patients with well-controlled type 2 diabetes mellitus","volume":"87","author":"Zabalgoitia","year":"2001","journal-title":"Am. J. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1161\/CIRCRESAHA.117.311586","article-title":"Diabetic Cardiomyopathy: An Update of Mechanisms Contributing to This Clinical Entity","volume":"122","author":"Jia","year":"2018","journal-title":"Circ. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.jchf.2021.05.019","article-title":"Differential Pathophysiological Mechanisms in Heart Failure With a Reduced or Preserved Ejection Fraction in Diabetes","volume":"9","author":"Packer","year":"2021","journal-title":"JACC Heart Fail."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1161\/CIRCRESAHA.118.311371","article-title":"Heart Failure in Type 2 Diabetes Mellitus","volume":"124","author":"Kenny","year":"2019","journal-title":"Circ. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1159\/000477436","article-title":"Vascularized Cardiac Spheroids as Novel 3D in vitro Models to Study Cardiac Fibrosis","volume":"204","author":"Figtree","year":"2017","journal-title":"Cells Tissues Organs"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1161\/ATVBAHA.121.316083","article-title":"Impaired Peripheral Microvascular Function and Risk of Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease","volume":"41","author":"Young","year":"2021","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_33","first-page":"88","article-title":"Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nature reviews","volume":"14","author":"Zheng","year":"2018","journal-title":"Endocrinology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e016280","DOI":"10.1136\/bmjopen-2017-016280","article-title":"Risk factors of diabetic retinopathy and sight-threatening diabetic retinopathy: A cross-sectional study of 13 473 patients with type 2 diabetes mellitus in mainland China","volume":"7","author":"Liu","year":"2017","journal-title":"BMJ Open"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1161\/CIRCULATIONAHA.111.025270","article-title":"Diabetes mellitus worsens diastolic left ventricular dysfunction in aortic stenosis through altered myocardial structure and cardiomyocyte stiffness","volume":"124","author":"Hamdani","year":"2011","journal-title":"Circulation"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1111\/febs.16330","article-title":"The blood-retina barrier in health and disease","volume":"290","author":"Campbell","year":"2023","journal-title":"FEBS J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1080\/09286580701396720","article-title":"Overview of epidemiologic studies of diabetic retinopathy","volume":"14","author":"Klein","year":"2007","journal-title":"Ophthalmic Epidemiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1016\/j.ophtha.2021.04.027","article-title":"Global Prevalence of Diabetic Retinopathy and Projection of Burden through 2045: Systematic Review and Meta-analysis","volume":"128","author":"Teo","year":"2021","journal-title":"Ophthalmology"},{"key":"ref_39","unstructured":"(2017). Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet, 390, 1151\u20131210."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1001\/jamaophthalmol.2017.0988","article-title":"Association of Diabetic Macular Edema and Proliferative Diabetic Retinopathy With Cardiovascular Disease: A Systematic Review and Meta-analysis","volume":"135","author":"Xie","year":"2017","journal-title":"JAMA Ophthalmol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"957","DOI":"10.2337\/diacare.23.7.957","article-title":"High cardiovascular disease mortality in subjects with visual impairment caused by diabetic retinopathy","volume":"23","author":"Rajala","year":"2000","journal-title":"Diabetes Care"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.2337\/diabetes.54.6.1615","article-title":"The pathobiology of diabetic complications: A unifying mechanism","volume":"54","author":"Brownlee","year":"2005","journal-title":"Diabetes"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s10735-007-9159-5","article-title":"Adhesion molecules (ICAM-1 and VCAM-1) and diabetic retinopathy in type 2 diabetes","volume":"39","author":"Khalfaoui","year":"2008","journal-title":"J. Mol. Histol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"E715","DOI":"10.1073\/pnas.1111600109","article-title":"Diabetes promotes an inflammatory macrophage phenotype and atherosclerosis through acyl-CoA synthetase 1","volume":"109","author":"Kanter","year":"2012","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"4243","DOI":"10.1093\/eurheartj\/ehy596","article-title":"Heart failure and diabetes: Metabolic alterations and therapeutic interventions: A state-of-the-art review from the Translational Research Committee of the Heart Failure Association-European Society of Cardiology","volume":"39","author":"Maack","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/S0140-6736(54)90924-1","article-title":"Diabetic angiopathy: A specific vascular disease","volume":"266","author":"Lundbaek","year":"1954","journal-title":"Lancet"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e315","DOI":"10.3399\/bjgp16X684961","article-title":"Practical Classification Guidelines for Diabetes in patients treated with insulin: A cross-sectional study of the accuracy of diabetes diagnosis","volume":"66","author":"Hope","year":"2016","journal-title":"Br. J. Gen. Pract."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.jcjd.2013.07.003","article-title":"MicroRNAs: The underlying mediators of pathogenetic processes in vascular complications of diabetes","volume":"37","author":"Ruiz","year":"2013","journal-title":"Can. J. Diabetes"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Borghetti, G., von Lewinski, D., Eaton, D.M., Sourij, H., Houser, S.R., and Wallner, M. (2018). Diabetic Cardiomyopathy: Current and Future Therapies. Beyond Glycemic Control. Front. Physiol., 9.","DOI":"10.3389\/fphys.2018.01514"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.2215\/CJN.11491116","article-title":"Diabetic Kidney Disease: Challenges, Progress, and Possibilities","volume":"12","author":"Alicic","year":"2017","journal-title":"Clin. J. Am. Soc. Nephrol. CJASN"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1681\/ASN.2012070718","article-title":"Kidney disease and increased mortality risk in type 2 diabetes","volume":"24","author":"Afkarian","year":"2013","journal-title":"J. Am. Soc. Nephrol. JASN"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1056\/NEJM198402093100605","article-title":"Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes","volume":"310","author":"Mogensen","year":"1984","journal-title":"N. Engl. J. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2450","DOI":"10.1001\/archinte.1992.00400240070012","article-title":"Prevalence of, and risk factors for, angiographically determined coronary artery disease in type I-diabetic patients with nephropathy","volume":"152","author":"Manske","year":"1992","journal-title":"Arch. Intern. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1016\/S0140-6736(88)92657-8","article-title":"Microalbuminuria as predictor of vascular disease in non-diabetic subjects. Islington Diabetes Survey","volume":"2","author":"Yudkin","year":"1988","journal-title":"Lancet"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1136\/bmj.312.7035.871","article-title":"Cohort study of predictive value of urinary albumin excretion for atherosclerotic vascular disease in patients with insulin dependent diabetes","volume":"312","author":"Deckert","year":"1996","journal-title":"BMJ"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1136\/bmj.294.6588.1651","article-title":"Proteinuria: Value as predictor of cardiovascular mortality in insulin dependent diabetes mellitus","volume":"294","author":"Kreiner","year":"1987","journal-title":"Br. Med. J. (Clin. Res. Ed.)"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1001\/archinte.1997.00440340025002","article-title":"The association of microalbuminuria and mortality in non-insulin-dependent diabetes mellitus. A systematic overview of the literature","volume":"157","author":"Dinneen","year":"1997","journal-title":"Arch. Intern. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"S54","DOI":"10.1007\/PL00002940","article-title":"Risk factors for cardiovascular mortality and morbidity: The WHO Mutinational Study of Vascular Disease in Diabetes","volume":"44","author":"Fuller","year":"2001","journal-title":"Diabetologia"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"426","DOI":"10.2337\/diab.43.3.426","article-title":"PAI-1 and factor VII activity are higher in IDDM patients with microalbuminuria","volume":"43","author":"Gruden","year":"1994","journal-title":"Diabetes"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"653","DOI":"10.7326\/0003-4819-125-8-199610150-00005","article-title":"Association of fibrinogen with glycemic control and albumin excretion rate in patients with non-insulin-dependent diabetes mellitus","volume":"125","author":"Bruno","year":"1996","journal-title":"Ann. Intern. Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"883","DOI":"10.2147\/VHRM.S11681","article-title":"Diabetic cardiomyopathy: From the pathophysiology of the cardiac myocytes to current diagnosis and management strategies","volume":"6","author":"Voulgari","year":"2010","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Coppola, A., Conte, S., Pastore, D., Chiereghin, F., and Donadel, G. (2024). Multifractal Heart Rate Value Analysis: A Novel Approach for Diabetic Neuropathy Diagnosis. Healthcare, 12.","DOI":"10.3390\/healthcare12020234"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1002\/dmrr.1239","article-title":"Cardiovascular autonomic neuropathy in diabetes: Clinical impact, assessment, diagnosis, and management","volume":"27","author":"Spallone","year":"2011","journal-title":"Diabetes\/Metab. Res. Rev."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1016\/j.jcmg.2010.09.014","article-title":"Association of cardiac autonomic neuropathy with subclinical myocardial dysfunction in type 2 diabetes","volume":"3","author":"Sacre","year":"2010","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Vinik, A.I., Casellini, C., Parson, H.K., Colberg, S.R., and Nevoret, M.L. (2018). Cardiac Autonomic Neuropathy in Diabetes: A Predictor of Cardiometabolic Events. Front. Neurosci., 12.","DOI":"10.3389\/fnins.2018.00591"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Oost, L.J., Kurstjens, S., Ma, C., Hoenderop, J.G.J., Tack, C.J., and de Baaij, J.H.F. (2022). Magnesium increases insulin-dependent glucose uptake in adipocytes. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.986616"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"El-Malahi, O., Mohajeri, D., Bauerle, A., Mincu, R., Rothenaicher, K., Ullrich, G., Rammos, C., Teufel, M., Rassaf, T., and Lortz, J. (2024). The Effect of Stress-Reducing Interventions on Heart Rate Variability in Cardiovascular Disease: A Systematic Review and Meta-Analysis. Life, 14.","DOI":"10.3390\/life14060749"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1007\/s10865-024-00468-4","article-title":"Effects of stress management interventions on heart rate variability in adults with cardiovascular disease: A systematic review and meta-analysis","volume":"47","author":"Gathright","year":"2024","journal-title":"J. Behav. Med."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Yugar, L.B.T., Yugar-Toledo, J.C., Dinamarco, N., Sedenho-Prado, L.G., Moreno, B.V.D., Rubio, T.A., Fattori, A., Rodrigues, B., Vilela-Martin, J.F., and Moreno, H. (2023). The Role of Heart Rate Variability (HRV) in Different Hypertensive Syndromes. Diagnostics, 13.","DOI":"10.3390\/diagnostics13040785"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"403","DOI":"10.4269\/ajtmh.19-0720","article-title":"Heart Rate Variability as an Indicator of Autonomic Nervous System Disturbance in Tetanus","volume":"102","author":"Duong","year":"2020","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.diabres.2003.10.009","article-title":"Low heart rate variability is a risk factor for sudden cardiac death in type 2 diabetes","volume":"64","author":"Kataoka","year":"2004","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1093\/eurheartj\/ehy808","article-title":"Resting heart rate and cardiovascular outcomes in diabetic and non-diabetic individuals at high cardiovascular risk analysis from the ONTARGET\/TRANSCEND trials","volume":"41","author":"Bohm","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"5133","DOI":"10.1073\/pnas.1215840110","article-title":"B cells promote inflammation in obesity and type 2 diabetes through regulation of T-cell function and an inflammatory cytokine profile","volume":"110","author":"DeFuria","year":"2013","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1016\/j.jacc.2020.01.014","article-title":"Inflammation in Heart Failure: JACC State-of-the-Art Review","volume":"75","author":"Murphy","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"2063","DOI":"10.2337\/db18-1231","article-title":"Role of CCR2 in the Development of Streptozotocin-Treated Diabetic Cardiomyopathy","volume":"68","author":"Tan","year":"2019","journal-title":"Diabetes"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.2174\/0929867324666170407123522","article-title":"Metaflammation: Tissue-Specific Alterations of the NLRP3 Inflammasome Platform in Metabolic Syndrome","volume":"25","author":"Mastrocola","year":"2018","journal-title":"Curr. Med. Chem."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"107001","DOI":"10.1016\/j.vph.2022.107001","article-title":"Aging, sex and NLRP3 inflammasome in cardiac ischaemic disease","volume":"145","author":"Alloatti","year":"2022","journal-title":"Vasc. Pharmacol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1002\/ctm2.13","article-title":"NLRP3 inflammasome, an immune-inflammatory target in pathogenesis and treatment of cardiovascular diseases","volume":"10","author":"Wang","year":"2020","journal-title":"Clin. Transl. Med."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1007\/s12265-022-10286-1","article-title":"NLRP3 Inflammasome: A Novel Insight into Heart Failure","volume":"16","author":"Wang","year":"2023","journal-title":"J. Cardiovasc. Transl. Res."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1097\/FJC.0000000000000946","article-title":"NLRP3 Inflammasome: A New Promising Therapeutic Target to Treat Heart Failure","volume":"77","author":"Crea","year":"2021","journal-title":"J. Cardiovasc. Pharmacol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.jtos.2024.09.007","article-title":"Recent advances in NLRP3 inflammasome in corneal diseases: Preclinical insights and therapeutic implications","volume":"34","author":"Ge","year":"2024","journal-title":"Ocul. Surf."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Shimizu, H., Sakimoto, T., and Yamagami, S. (2019). Pro-inflammatory role of NLRP3 inflammasome in experimental sterile corneal inflammation. Sci. Rep., 9.","DOI":"10.1038\/s41598-019-46116-9"},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Zheng, E., Warchol, I., Mejza, M., Mozdzan, M., Strzeminska, M., Bajer, A., Madura, P., Zak, J., and Plewka, M. (2025). Exploring Anti-Inflammatory Treatment as Upstream Therapy in the Management of Atrial Fibrillation. J. Clin. Med., 14.","DOI":"10.3390\/jcm14030882"},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Xing, Y., Yan, L., Li, X., Xu, Z., Wu, X., Gao, H., Chen, Y., Ma, X., Liu, J., and Zhang, J. (2023). The relationship between atrial fibrillation and NLRP3 inflammasome: A gut microbiota perspective. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1273524"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"2349","DOI":"10.1016\/j.jacc.2022.03.379","article-title":"Inflammasome Signaling in Atrial Fibrillation: JACC State-of-the-Art Review","volume":"79","author":"Ajoolabady","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"152786","DOI":"10.1155\/2013\/152786","article-title":"LOX-1, OxLDL, and atherosclerosis","volume":"2013","author":"Pirillo","year":"2013","journal-title":"Mediat. Inflamm."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1038\/nature01323","article-title":"Inflammation in atherosclerosis","volume":"420","author":"Libby","year":"2002","journal-title":"Nature"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1161\/01.CIR.104.3.365","article-title":"Current concepts of the pathogenesis of the acute coronary syndromes","volume":"104","author":"Libby","year":"2001","journal-title":"Circulation"},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Nagai, M., Shityakov, S., Smetak, M., Hunkler, H.J., Bar, C., Schlegel, N., Thum, T., and Forster, C.Y. (2023). Blood Biomarkers in Takotsubo Syndrome Point to an Emerging Role for Inflammaging in Endothelial Pathophysiology. Biomolecules, 13.","DOI":"10.1101\/2023.04.05.23288213"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1152\/physiolgenomics.00048.2006","article-title":"Angiopoietin-1 and vascular endothelial growth factor induce expression of inflammatory cytokines before angiogenesis","volume":"27","author":"Aplin","year":"2006","journal-title":"Physiol. Genom."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1016\/j.mehy.2004.10.016","article-title":"Inflammation may be a bridge connecting hypertension and atherosclerosis","volume":"64","author":"Li","year":"2005","journal-title":"Med. Hypotheses"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/j.jcmg.2021.12.008","article-title":"Diabetes and Myocardial Fibrosis: A Systematic Review and Meta-Analysis","volume":"15","author":"Salvador","year":"2022","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1002\/cne.900670104","article-title":"Quantitative studies of the vagus nerve in the cat. I. The ratio of sensory to motor fibers","volume":"67","author":"Foley","year":"1937","journal-title":"J. Comp. Neurol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1111\/head.12647","article-title":"Vagus Nerve and Vagus Nerve Stimulation, a Comprehensive Review: Part I","volume":"56","author":"Yuan","year":"2016","journal-title":"Headache"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1007\/s40473-014-0010-5","article-title":"Vagus Nerve Stimulation","volume":"1","author":"Howland","year":"2014","journal-title":"Curr. Behav. Neurosci. Rep."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S1566-0702(00)00215-0","article-title":"Functional and chemical anatomy of the afferent vagal system","volume":"85","author":"Berthoud","year":"2000","journal-title":"Auton. Neurosci."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1038\/sj.npp.1301082","article-title":"VNS therapy in treatment-resistant depression: Clinical evidence and putative neurobiological mechanisms","volume":"31","author":"Nemeroff","year":"2006","journal-title":"Neuropsychopharmacology"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1038\/nri2566","article-title":"Reflex control of immunity","volume":"9","author":"Tracey","year":"2009","journal-title":"Nat. Rev. Immunol."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1038\/nri.2015.5","article-title":"The role of inflammation in depression: From evolutionary imperative to modern treatment target","volume":"16","author":"Miller","year":"2016","journal-title":"Nat. Rev. Immunol."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1038\/nri3661","article-title":"Cytokines in inflammatory bowel disease","volume":"14","author":"Neurath","year":"2014","journal-title":"Nat. Rev. Immunol."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.neubiorev.2019.03.018","article-title":"Glucose signaling in the brain and periphery to memory","volume":"110","author":"Hossain","year":"2020","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Benichou, T., Pereira, B., Mermillod, M., Tauveron, I., Pfabigan, D., Maqdasy, S., and Dutheil, F. (2018). Heart rate variability in type 2 diabetes mellitus: A systematic review and meta-analysis. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0195166"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1111\/joa.13122","article-title":"The anatomical basis for transcutaneous auricular vagus nerve stimulation","volume":"236","author":"Butt","year":"2020","journal-title":"J. Anat."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1002\/ca.1089","article-title":"The nerve supply of the human auricle","volume":"15","author":"Peuker","year":"2002","journal-title":"Clin Anat"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1159\/000325225","article-title":"The application of vagus nerve stimulation and deep brain stimulation in depression","volume":"64","author":"Mohr","year":"2011","journal-title":"Neuropsychobiology"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/S0022-3956(03)00074-8","article-title":"A review of functional neuroimaging studies of vagus nerve stimulation (VNS)","volume":"37","author":"Chae","year":"2003","journal-title":"J. Psychiatr. Res."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1111\/j.1528-1157.1998.tb01448.x","article-title":"Brain blood flow alterations induced by therapeutic vagus nerve stimulation in partial epilepsy: I. Acute effects at high and low levels of stimulation","volume":"39","author":"Henry","year":"1998","journal-title":"Epilepsia"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1007\/s00702-012-0908-6","article-title":"Auricular transcutaneous electrical nerve stimulation in depressed patients: A randomized controlled pilot study","volume":"120","author":"Hein","year":"2013","journal-title":"J. Neural. Transm."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.jad.2016.02.031","article-title":"Effect of transcutaneous auricular vagus nerve stimulation on major depressive disorder: A nonrandomized controlled pilot study","volume":"195","author":"Rong","year":"2016","journal-title":"J. Affect. Disord."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1212\/WNL.59.6_suppl_4.S3","article-title":"Therapeutic mechanisms of vagus nerve stimulation","volume":"59","author":"Henry","year":"2002","journal-title":"Neurology"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"S255","DOI":"10.4103\/2152-7806.103015","article-title":"Vagus nerve stimulation for epilepsy: A review of central mechanisms","volume":"3","author":"Krahl","year":"2012","journal-title":"Surg. Neurol. Int."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/S0920-1211(03)00107-4","article-title":"Correlation between GABA(A) receptor density and vagus nerve stimulation in individuals with drug-resistant partial epilepsy","volume":"55","author":"Marrosu","year":"2003","journal-title":"Epilepsy Res."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"102894","DOI":"10.1016\/j.autneu.2021.102894","article-title":"Transcutaneous auricular vagus nerve stimulation and heart rate variability: Analysis of parameters and targets","volume":"236","author":"Machetanz","year":"2021","journal-title":"Auton. Neurosci. Basic Clin."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"e14447","DOI":"10.7717\/peerj.14447","article-title":"Ear your heart: Transcutaneous auricular vagus nerve stimulation on heart rate variability in healthy young participants","volume":"10","author":"Forte","year":"2022","journal-title":"PeerJ"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"105002","DOI":"10.1088\/1361-6579\/ac24e6","article-title":"Bursted auricular vagus nerve stimulation alters heart rate variability in healthy subjects","volume":"42","author":"Szeles","year":"2021","journal-title":"Physiol. Meas."},{"key":"ref_116","doi-asserted-by":"crossref","unstructured":"Gianlorenco, A.C., Pacheco-Barrios, K., Daibes, M., Camargo, L., Choi, H., Song, J.J., and Fregni, F. (2024). Age as an Effect Modifier of the Effects of Transcutaneous Auricular Vagus Nerve Stimulation (taVNS) on Heart Rate Variability in Healthy Subjects. J. Clin. Med., 13.","DOI":"10.3390\/jcm13144267"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4093\/dmj.2018.0259","article-title":"Update on the Impact, Diagnosis and Management of Cardiovascular Autonomic Neuropathy in Diabetes: What Is Defined, What Is New, and What Is Unmet","volume":"43","author":"Spallone","year":"2019","journal-title":"Diabetes Metab. J."},{"key":"ref_118","first-page":"1995","article-title":"Cardiac Autonomic Neuropathy in Obesity, the Metabolic Syndrome and Prediabetes: A Narrative Review","volume":"10","author":"Williams","year":"2019","journal-title":"Diabetes Ther. Res. Treat. Educ. Diabetes Relat. Disord."},{"key":"ref_119","first-page":"299","article-title":"Heart rate variability and myocardial infarction: Systematic literature review and metanalysis","volume":"13","author":"Buccelletti","year":"2009","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_120","doi-asserted-by":"crossref","unstructured":"Im, S.I., Kim, S.J., Bae, S.H., Kim, B.J., Heo, J.H., Kwon, S.K., Cho, S.P., Shim, H., Park, J.H., and Kim, H.S. (2023). Real-time heart rate variability according to ambulatory glucose profile in patients with diabetes mellitus. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1249709"},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1007\/s00125-024-06129-0","article-title":"Transcutaneous vagal nerve stimulation for treating gastrointestinal symptoms in individuals with diabetes: A randomised, double-blind, sham-controlled, multicentre trial","volume":"67","author":"Kornum","year":"2024","journal-title":"Diabetologia"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1111\/ner.13521","article-title":"Reassessment of the Effect of Transcutaneous Auricular Vagus Nerve Stimulation Using a Novel Burst Paradigm on Cardiac Autonomic Function in Healthy Young Adults","volume":"25","author":"Shen","year":"2022","journal-title":"Neuromodulation"},{"key":"ref_123","doi-asserted-by":"crossref","unstructured":"Wu, Y.R., Su, W.S., Lin, K.D., and Lin, I.M. (Appl. Psychophysiol. Biofeedback, 2024). Effect of Heart Rate Variability Biofeedback on Cardiac Autonomic Activation and Diabetes Self-Care in Patients with Type II Diabetes Mellitus, Appl. Psychophysiol. Biofeedback, Online ahead of print.","DOI":"10.1007\/s10484-024-09666-x"},{"key":"ref_124","first-page":"812","article-title":"Mechanism of melatonin-mediated antihyperglycemic effect of transcutaneous auricular vagus nerve stimulation","volume":"48","author":"Zhang","year":"2023","journal-title":"Zhen Ci Yan Jiu = Acupunct. Res."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1111\/j.1365-2796.2008.02023.x","article-title":"Heart rate variability, overnight urinary norepinephrine and C-reactive protein: Evidence for the cholinergic anti-inflammatory pathway in healthy human adults","volume":"265","author":"Thayer","year":"2009","journal-title":"J. Intern. Med."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"363","DOI":"10.37349\/ent.2023.00056","article-title":"Exploration of transcutaneous vagus nerve stimulation as a treatment option for adjuvant cancer and heart failure therapy","volume":"3","author":"Frank","year":"2023","journal-title":"Explor. Neuroprotective Ther."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1038\/35013070","article-title":"Vagus nerve stimulation attenuates the systemic inflammatory response to endotoxin","volume":"405","author":"Borovikova","year":"2000","journal-title":"Nature"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1172\/JCI30555","article-title":"Physiology and immunology of the cholinergic antiinflammatory pathway","volume":"117","author":"Tracey","year":"2007","journal-title":"J. Clin. Investig."},{"key":"ref_129","doi-asserted-by":"crossref","unstructured":"Kaniusas, E., Kampusch, S., Tittgemeyer, M., Panetsos, F., Gines, R.F., Papa, M., Kiss, A., Podesser, B., Cassara, A.M., and Tanghe, E. (2019). Current Directions in the Auricular Vagus Nerve Stimulation I\u2014A Physiological Perspective. Front. Neurosci., 13.","DOI":"10.3389\/fnins.2019.00854"},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"e038677","DOI":"10.1136\/bmjopen-2020-038677","article-title":"Study protocol for a multicentre, randomised, parallel group, sham-controlled clinical trial investigating the effect of transcutaneous vagal nerve stimulation on gastrointestinal symptoms in people with diabetes complicated with diabetic autonomic neuropathy: The DAN-VNS Study","volume":"11","author":"Okdahl","year":"2021","journal-title":"BMJ Open"},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1136\/bmj.321.7258.405","article-title":"Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): Prospective observational study","volume":"321","author":"Stratton","year":"2000","journal-title":"BMJ"},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s00125-017-4390-4","article-title":"Diabetic cardiomyopathy: A hyperglycaemia-; insulin-resistance-induced heart disease","volume":"61","author":"Jia","year":"2018","journal-title":"Diabetologia"},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"109163","DOI":"10.1016\/j.isci.2024.109163","article-title":"Noninvasive neuromodulation protects against doxorubicin-induced cardiotoxicity and inhibits tumor growth","volume":"27","author":"Xie","year":"2024","journal-title":"iScience"},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"e030539","DOI":"10.1161\/JAHA.123.030539","article-title":"Vagus Nerve Stimulation and Inflammation in Cardiovascular Disease: A State-of-the-Art Review","volume":"12","author":"Bazoukis","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"e003265","DOI":"10.1136\/rmdopen-2023-003265","article-title":"Transcutaneous auricular branch vagal nerve stimulation as a non-invasive add-on therapeutic approach for pain in systemic sclerosis","volume":"9","author":"Bellocchi","year":"2023","journal-title":"RMD Open"},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1177\/1932296814528616","article-title":"Cardiovascular autonomic neuropathy is associated with macrovascular risk factors in type 2 diabetes: New technology used for routine large-scale screening adds new insight","volume":"8","author":"Fleischer","year":"2014","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1111\/dom.13620","article-title":"The renoprotective effects of sodium-glucose cotransporter 2 inhibitors versus placebo in patients with type 2 diabetes with or without prevalent kidney disease: A systematic review and meta-analysis","volume":"21","author":"Wang","year":"2019","journal-title":"Diabetes Obes. Metab."},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"2295","DOI":"10.1056\/NEJMoa1811744","article-title":"Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy","volume":"380","author":"Perkovic","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1177\/15459683231177595","article-title":"Understanding the Neuroplastic Effects of Auricular Vagus Nerve Stimulation in Animal Models of Stroke: A Systematic Review and Meta-Analysis","volume":"37","author":"Parente","year":"2023","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.tcm.2023.07.003","article-title":"Vagus nerve stimulation for cardiovascular diseases: Is there light at the end of the tunnel?","volume":"34","author":"Zafeiropoulos","year":"2023","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1152\/physrev.00007.2009","article-title":"Sympathetic nervous system overactivity and its role in the development of cardiovascular disease","volume":"90","author":"Malpas","year":"2010","journal-title":"Physiol. Rev."},{"key":"ref_142","doi-asserted-by":"crossref","unstructured":"Hua, K., Cummings, M., Bernatik, M., Brinkhaus, B., Usichenko, T., and Dietzel, J. (2023). Cardiovascular effects of auricular stimulation -a systematic review and meta-analysis of randomized controlled clinical trials. Front. Neurosci., 17.","DOI":"10.3389\/fnins.2023.1227858"},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1016\/j.brs.2017.07.013","article-title":"Transcutaneous auricular vagal nerve stimulation (taVNS) might be a mechanism behind the analgesic effects of auricular acupuncture","volume":"10","author":"Usichenko","year":"2017","journal-title":"Brain Stimul."},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1007\/s12264-020-00619-y","article-title":"Transcutaneous Auricular Vagus Nerve Stimulation: From Concept to Application","volume":"37","author":"Wang","year":"2021","journal-title":"Neurosci. Bull."},{"key":"ref_145","doi-asserted-by":"crossref","unstructured":"Ruhnau, P., and Zaehle, T. (2021). Transcranial Auricular Vagus Nerve Stimulation (taVNS) and Ear-EEG: Potential for Closed-Loop Portable Non-invasive Brain Stimulation. Front. Hum. Neurosci., 15.","DOI":"10.3389\/fnhum.2021.699473"},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"102893","DOI":"10.1016\/j.autneu.2021.102893","article-title":"Effects of transcutaneous auricular vagus nerve stimulation on cardiovascular autonomic control in health and disease","volume":"236","author":"Carandina","year":"2021","journal-title":"Auton. Neurosci. Basic Clin."},{"key":"ref_147","doi-asserted-by":"crossref","unstructured":"Zhai, W., Jiao, H., Zhuang, Y., Yang, Y., Zhang, J., Wang, Y., Zhao, Y.N., Zhang, S., He, J., and Rong, P. (2023). Optimizing the modulation paradigm of transcutaneous auricular vagus nerve stimulation in patients with disorders of consciousness: A prospective exploratory pilot study protocol. Front. Neurosci., 17.","DOI":"10.3389\/fnins.2023.1145699"},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1113\/EP087351","article-title":"Low-level transcutaneous vagus nerve stimulation attenuates cardiac remodelling in a rat model of heart failure with preserved ejection fraction","volume":"104","author":"Zhou","year":"2019","journal-title":"Exp. Physiol."},{"key":"ref_149","doi-asserted-by":"crossref","unstructured":"Wu, Z., Liao, J., Liu, Q., Zhou, S., and Chen, M. (2023). Chronic vagus nerve stimulation in patients with heart failure: Challenge or failed translation?. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1052471"},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.jacc.2016.03.525","article-title":"Vagus Nerve Stimulation for the Treatment of Heart Failure: The INOVATE-HF Trial","volume":"68","author":"Gold","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"e023582","DOI":"10.1161\/JAHA.121.023582","article-title":"Neuromodulation of Inflammation to Treat Heart Failure With Preserved Ejection Fraction: A Pilot Randomized Clinical Trial","volume":"11","author":"Stavrakis","year":"2022","journal-title":"J. Am. Heart Assoc."},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.ccep.2023.12.001","article-title":"Non-invasive Neuromodulation of Arrhythmias","volume":"16","author":"Farhat","year":"2024","journal-title":"Card. Electrophysiol. Clin."},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"e009288","DOI":"10.1161\/CIRCHEARTFAILURE.122.009288","article-title":"Transcutaneous Vagus Nerve Stimulation Ameliorates the Phenotype of Heart Failure With Preserved Ejection Fraction Through Its Anti-Inflammatory Effects","volume":"15","author":"Elkholey","year":"2022","journal-title":"Circ. Heart Fail."},{"key":"ref_154","doi-asserted-by":"crossref","unstructured":"Forster, C.Y., Kunzel, S.R., Shityakov, S., and Stavrakis, S. (2024). Synergistic Effects of Weight Loss and Catheter Ablation: Can microRNAs Serve as Predictive Biomarkers for the Prevention of Atrial Fibrillation Recurrence?. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25094689"}],"container-title":["Biomolecules"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2218-273X\/15\/4\/499\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:05:19Z","timestamp":1760029519000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2218-273X\/15\/4\/499"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,29]]},"references-count":154,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["biom15040499"],"URL":"https:\/\/doi.org\/10.3390\/biom15040499","relation":{},"ISSN":["2218-273X"],"issn-type":[{"value":"2218-273X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,29]]}}}