Major ECG abnormalities highlight CVD risk in type 1 diabetes
medwireNews: Type 1 diabetes patients with major electrocardiographic (ECG) abnormalities have double the risk for cardiovascular (CVD) events of those with no such abnormalities, study findings indicate.
And there was a 30% increased risk for CVD events with each additional annual visit during which a diagnosis of major ECG abnormality, defined by the Minnesota Code for ECG classification, was retained.
This suggests that “ECG could be an additional tool for examining CVD risk in patients with type 1 diabetes,” Elsayed Soliman (Wake Forest School of Medicine, Winston-Salem, North Carolina, USA) and study co-authors remark.
During a median follow-up period of 19 years, 155 (11.9%) of 1306 patients with type 1 diabetes from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study developed myocardial infarction, stroke, confirmed angina, coronary artery revascularization, congestive heart failure, or death from any CVD. This gave a CVD event rate of 46.8 cases per 10,000 person–years.
The researchers found that study participants who experienced CVD events were more likely to be older, current smokers, have a longer duration of diabetes, and have higher levels of glycated hemoglobin, systolic blood pressure, diastolic blood pressure, non–high-density lipoprotein cholesterol, total cholesterol, triglycerides, and albuminuria at baseline than those who did not.
After adjusting for these potential confounders, the presence of any major ECG abnormalities as a time-varying covariate was associated with a 2.10-fold increased risk for CVD events when compared with no abnormality/normal ECG, and a 2.19-fold increased risk compared with minor or no abnormalities.
Patients with minor ECG abnormalities had no increased risk for CVD events.
Soliman and team say the mechanism by which major ECG abnormalities predict CVD outcome is unclear but suggest that such abnormalities are markers of subclinical cardiac disease, such as subclinical myocardial injury/ischemia, myocardial dysfunction, and susceptibility to conduction defects and arrhythmias that could be fatal alone or could lead to myocardial dysfunction.
They add that ECG abnormalities could indicate systemic disease negatively affecting the cardiovascular system, such as electrolyte imbalance resulting from kidney disease.
Writing in Diabetes Care, the researchers conclude: “Identifying risk markers/predictors such as ECG abnormalities in type 1 diabetes could help guide future efforts toward the development of risk stratification tools to identify those who may benefit from closer follow-up and earlier, more aggressive risk factor management.”
By Laura Cowen
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