Diabetes is the "black hand" of sudden death! Danish research

If you have diabetes, your risk of sudden cardiac death will increase by 2 to 4 times. Is diabetes itself a risk factor for sudden cardiac death independent of ischemic heart disease?

A recent Danish study analyzing 10 years of the country's mortality data provides some explanation for this.

The study showed that ischemic heart disease is the most common cause of sudden cardiac death, and 47% of autopsy results can be attributed to it. The incidence of coronary heart disease is similar in people with or without diabetes, but the incidence of sudden cardiac death in people with diabetes is 10 times higher than that in people without diabetes.

A concurrent commentary pointed out that diabetes-induced cardiac autonomic neuropathy may be one of the factors.

Cardiac autonomic neuropathy can lead to dysregulation of the sympathetic and parasympathetic nerves that control the cardiac electrophysiological ion channels, leading to the occurrence of arrhythmias.

It was previously believed that autonomic neuropathy was caused by the long-term accumulation of diabetes, but current studies have found that diabetic neuropathy, including cardiac autonomic neuropathy, can occur even in the prediabetes stage.

Cardiac autonomic neuropathy may be the result of the combined effects of vasa vasorum and neural oxidative stress. Genetic susceptibility may also be a cause, but there is currently little genetic research on cardiac autonomic neuropathy.

The commentary experts pointed out that it is necessary to carry out research on the genetic connection between cardiac autonomic neuropathy, sudden cardiac death and diabetes, as well as the mechanism of sudden cardiac death in diabetic patients in the future.

Figure 1 Possible pathways of sudden cardiac death caused by diabetes, in addition to ischemic heart disease and sudden arrhythmic death syndrome

The Danish study analyzed data on 14,294 deaths among people aged 1 to 49 from 2000 to 2009, of which 1,363 were sudden cardiac deaths.

Of the 14,294 deaths, 669 had diabetes, 118 (18%) died from sudden cardiac death, and 112 (17%) died from non-cardiac sudden cardiovascular disease.

Figure 2 Causes of death among people aged 1 to 35 years old due to diabetes from 2000 to 2009 and among people aged 36 to 49 years old due to diabetes from 2007 to 2009

In addition, among people aged 1 to 35 years, the incidence of sudden cardiac death in diabetic patients was 21.9/100,000 person-years, much higher than that in patients without diabetes (2.6/100,000 person-years).

Among people aged 36 to 49, the rate of sudden cardiac death in those with diabetes is still much higher than that in those without diabetes (119.8/100,000 person-years vs 19.7/100,000 person-years).

Figure 3 Incidence of sudden cardiac death in people of different age groups with type 1 diabetes, type 2 diabetes and without diabetes

The researchers pointed out that this study suggests the need for early cardiovascular risk monitoring and assessment in young diabetic patients.

source:

[1]Tan HL, van Dongen LH, Zimmerman DS. Sudden cardiac death in young patients with diabetes: a call to study additional causes beyond ischaemic heart disease. Eur Heart J. 2020, 41(28): 2707-2709.

[2]Lynge TH, Svane J, Pedersen-Bjergaard U, et al. Sudden cardiac death among persons with diabetes aged 1-49 years: a 10-year nationwide study of 14294 deaths in Denmark. Eur Heart J, 2020, 41(28): 2699-2706.

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