Sudden death tops CV death causes in type 2 diabetics with atherosclerosis
medwireNews: Sudden death is the most common cause of cardiovascular (CV) death among patients with type 2 diabetes and atherosclerotic CV disease, an analysis of TECOS data shows.
The study also revealed that patients who experience sudden death have a distinct demographic profile that differs from that of patients who die from other CV causes. Specifically, they had the youngest median age and were most likely to have a glycated hemoglobin (HbA1c) level of 7.5% or higher and be insulin users.
However, Abhinav Sharma (Duke University School of Medicine, Durham, North Carolina, USA) and colleagues say that “[a]dditional research is needed into the underlying mechanism that drives sudden death as well as strategies to reduce the risk of sudden death (e.g., improved glycemic control).”
Among the 1084 deaths that occurred in 14,671 TECOS participants during a median 3-year follow-up period, 530 (49%; 1.20 per 100 patient–years) were due to CV causes, 338 (31%; 0.77 per 100 patient–years) were due to non-CV causes, and the remaining 216 (20%; 0.49 per 100 patient–years) were of unknown cause.
Sudden death accounted for 27% of CV deaths, followed by acute myocardial infarction (MI) or stroke (21%), and heart failure (HF; 12%).
Among non-CV causes of death, malignancy was the most common, accounting for 46% of non-CV deaths.
In multivariate analyses, a lack of prior HF was associated with a significantly reduced risk for each of the specific CV causes of death, at hazard ratios of 0.29 for HF, 0.40 for sudden death, and 0.47 for acute MI or stroke.
Higher estimated glomerular filtration rate was also associated with reduced risks for sudden death and heart failure mortality, at a hazard ratio of 0.33 per log10 increase for both.
In addition, the researchers found that each 1% increase in HbA1c was associated with a significant 41% increased risk for sudden death, whereas a history of percutaneous coronary intervention was associated with a 39% decreased risk.
This latter finding suggests that “underlying obstructive coronary atherosclerosis may be a contributor to the mechanism underlying sudden death,” Sharma and co-authors write in Diabetes Care.
They add that the clinical variables they have found to be associated with CV mortality “may be considered when risk stratifying patients for therapies that prevent arrhythmic death, such as the implantable cardioverter defibrillator.”
The team concludes: “Preserving renal function and optimizing HF care may represent an option to improve outcomes among patients with diabetes and CV disease.”
By Laura Cowen
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