The risk of sudden cardiac death is much higher in people with type 1 and type 2 diabetes, especially among younger people, according to a study published in the European Heart Journal.
Sudden cardiac death, sudden and unexpected death due to a cardiac cause, … It is rare in apparently healthy young people, but this new analysis shows that diabetes significantly increases its incidence.
The work, led by Tobias Skilberd from the University Hospital of Copenhagen-Rijshospitalet (Denmark), assessed all deaths that occurred in the country in 2010.
Of the 54,028 deaths recorded, researchers identified 6862 attributed to sudden cardiac death by death certificatesHospital and autopsy reports. By cross-referencing this information with national diabetes registries, they compared risks between people with type 1 diabetes, type 2 diabetes, and the general population.
The results showed that sudden cardiac death was 3.7 times more frequent in people with type 1 diabetes and 6.5 times more frequent in people with type 2 diabetes. The relative difference was largest among those under 50 years of age, whose risks were seven times higher than their peers without diabetes.
The study also determined the impact of diabetes on life expectancy. For example, people with type 1 diabetes lived an average lifespan of 14.2 years less, while people with type 2 diabetes had an average lifespan of 7.9 years less.
Research shows that sudden cardiac death “is more common in people with diabetes of all ages and contributes significantly to decreased life expectancy,” says Skillebird. “Although the risk increases with age, the relative difference is particularly notable in young people with diabetes.”
Observational study
The authors recall that this is an observational study, so causality cannot be proven. However, the results underscore the importance of improving cardiovascular disease prevention in people with diabetes. Mechanisms that could explain this association include ischemic heart disease, hypoglycemia, and cardiac autonomic neuropathy, which contribute to arrhythmia and sudden death.
One limitation of this work is that it analyzes data from 2010, before the widespread use of SGLT2 inhibitors and GLP-1 agonists, drugs that are now part of the therapeutic arsenal and that can modify cardiovascular risk.
For people at very high risk of sudden death, implantable pacemakers may be an option.
Early times
The next step, the authors note, will be to identify subgroups of diabetes patients who could benefit from more specific preventive interventions.
In an accompanying editorial, Hannu Tan of UMC in Amsterdam (Netherlands) highlights that the study “identifies for the first time the extent to which sudden death contributes to loss of life expectancy in diabetes” and highlights that the risk is particularly high at early ages.
The editorial also highlights New lines of researchsuch as autonomous systems capable of detecting cardiac arrest through a device, for example, a smart watch, and automatically alerting emergency services, a technology that could be very useful for people with type 1 diabetes, who have frequent unattended events.