Cardiovascular autonomic neuropathy (CAN) is a serious complication of diabetes, often overlooked, affecting the autonomic nerves that control the heart and blood vessels. It leads to abnormalities in heart rate control and vascular dynamics. CAN is associated with various clinical manifestations, including resting tachycardia, orthostatic hypotension, exercise intolerance, intraoperative cardiovascular instability, silent myocardial infarction, and increased mortality risk. Early detection through autonomic function tests is crucial for effective management. Epidemiological studies show varying prevalence rates of CAN in diabetic populations, influenced by factors such as age, duration of diabetes, and glycemic control. CAN is often linked with other diabetic complications like distal symmetric polyneuropathy and microangiopathy. Risk factors for reduced heart rate variability include age, diabetes, obesity, and smoking. Clinical manifestations of CAN include resting tachycardia, orthostatic hypotension, and exercise intolerance. Patients with CAN may experience symptoms like dizziness, fainting, and syncope upon standing. Silent myocardial ischemia is also common, with CAN increasing the risk of myocardial infarction and mortality. CAN is associated with a higher risk of sudden death due to arrhythmias and cardiac arrest. CAN is linked to increased cardiovascular mortality, with studies showing a relative risk of 2.14 for mortality in patients with CAN. The mechanisms behind this increased risk are complex, involving autonomic dysfunction, sympathetic imbalance, and impaired cardiac function. CAN is also associated with major cardiovascular events, including myocardial infarction, heart failure, and stroke. CAN can be diagnosed through various tests, including cardiovascular autonomic reflex tests, 24-hour HRV, and cardiac radionuclide imaging. These tests assess autonomic function and sympathetic innervation. Treatment options include lifestyle modifications, pharmacological interventions, and autonomic testing to guide management. CAN can be reversed or improved with intensive glycemic control, lifestyle changes, and pharmacological treatments. Studies show that ACE inhibitors and angiotensin receptor blockers can improve CAN and left ventricular dysfunction. The importance of early diagnosis and management of CAN is emphasized to reduce mortality and improve outcomes in diabetic patients.Cardiovascular autonomic neuropathy (CAN) is a serious complication of diabetes, often overlooked, affecting the autonomic nerves that control the heart and blood vessels. It leads to abnormalities in heart rate control and vascular dynamics. CAN is associated with various clinical manifestations, including resting tachycardia, orthostatic hypotension, exercise intolerance, intraoperative cardiovascular instability, silent myocardial infarction, and increased mortality risk. Early detection through autonomic function tests is crucial for effective management. Epidemiological studies show varying prevalence rates of CAN in diabetic populations, influenced by factors such as age, duration of diabetes, and glycemic control. CAN is often linked with other diabetic complications like distal symmetric polyneuropathy and microangiopathy. Risk factors for reduced heart rate variability include age, diabetes, obesity, and smoking. Clinical manifestations of CAN include resting tachycardia, orthostatic hypotension, and exercise intolerance. Patients with CAN may experience symptoms like dizziness, fainting, and syncope upon standing. Silent myocardial ischemia is also common, with CAN increasing the risk of myocardial infarction and mortality. CAN is associated with a higher risk of sudden death due to arrhythmias and cardiac arrest. CAN is linked to increased cardiovascular mortality, with studies showing a relative risk of 2.14 for mortality in patients with CAN. The mechanisms behind this increased risk are complex, involving autonomic dysfunction, sympathetic imbalance, and impaired cardiac function. CAN is also associated with major cardiovascular events, including myocardial infarction, heart failure, and stroke. CAN can be diagnosed through various tests, including cardiovascular autonomic reflex tests, 24-hour HRV, and cardiac radionuclide imaging. These tests assess autonomic function and sympathetic innervation. Treatment options include lifestyle modifications, pharmacological interventions, and autonomic testing to guide management. CAN can be reversed or improved with intensive glycemic control, lifestyle changes, and pharmacological treatments. Studies show that ACE inhibitors and angiotensin receptor blockers can improve CAN and left ventricular dysfunction. The importance of early diagnosis and management of CAN is emphasized to reduce mortality and improve outcomes in diabetic patients.