Diabetes Linked to All-Cause and Sudden Death in the Young

Marlene Busko

November 15, 2017

ANAHEIM, CA — Among patients ranging in age from infants to young adults who died in Denmark over the course of a decade, rates of all-cause death and sudden cardiac death were disproportionately higher among those who had type 1 or type 2 diabetes compared with those without diabetes, in a new study[1].

Jesper Svane

The findings showed that during a 10-year period, people aged 1 to 49 years with diabetes had a fivefold increased risk of all-cause death and a sevenfold increased risk of sudden cardiac death compared with their peers without diabetes, Jesper Svane (Copenhagen University Hospital, Rigshospitalet, Denmark) told a press conference here.

He presented their results at the American Heart Association (AHA) 2017 Scientific Sessions.

"We always knew that persons with diabetes have increased risks of all kinds of diseases and dying, but I think it's underestimated how much diabetes has an impact among the young and particularly on heart disease," Svane told theheart.org | Medscape Cardiology.

"We know from previous studies that persons who die from sudden cardiac arrest have complained about either chest pain or syncope prior to death, so particularly among persons with diabetes, this needs to be taken seriously," he said.

The study is "another spotlight" showing that "diabetes is a powerful predictor of premature heart disease and that we should be that much more careful in those patients, even in young people," AHA spokesperson Dr Vincent Bufalino (Advocate Health Care, Chicago) said in an interview.

However, the registry lacked data about patient symptoms, glycemic control, or use of an insulin pump, Svane admitted, so some of the deaths classified as due to sudden cardiac arrest may have been related to glycemia.

It is important not to overinterpret this data, Dr Robert H Eckel (University of Colorado School of Medicine, Aurora, CO) cautioned  theheart.org | Medscape Cardiology, since this was an epidemiologic study with autopsies in only a fraction of patients, and the researchers lacked details surrounding the cause of death.

"Sudden cardiac deaths are usually arrhythmogenic," Eckel noted, and hyperglycemia has been associated with cardiac rhythm disturbances.

This type of epidemiologic study asks a question, but further research is needed to explain the findings.

"If they could get some additional clinical information as to why those people died suddenly it would be helpful," Bufalino agreed.

In the meantime, "the study raises another flag as to the seriousness of diabetes."

Deaths in Young People With, Without Diabetes

Svane and colleagues aimed to determine the rates of all-cause and sudden cardiac death among children and younger adults with and without diabetes in Denmark.

They identified deaths among 1- to 35-year-olds from 2000 to 2009 and among 36- to 49-year-olds in 2007–2009 from the Danish Causes of Death Register.

Among these deaths, people were identified as having type 1 or type 2 diabetes if they had filled prescriptions for insulin alone or a noninsulin antidiabetic agent (with or without insulin), respectively.

During this 10-year period, 14,294 people aged 1 to 49 died. Two-thirds of the deaths were in males, and overall, autopsies were performed in about a third of the cases.

The prevalence of diabetes was 5% (669 deceased people); of these, 70% (471) had type 1 diabetes and 30% (198) had type 2 diabetes.

More deceased individuals with diabetes than without diabetes had cardiovascular disease (20% vs 7%), but fewer with diabetes than without diabetes had autopsies (27% vs 33%).

There were 235 deaths from all causes per 100,000 person-years among individuals with diabetes vs 51 all-cause deaths per 100,000 person-years among those without diabetes (mortality risk ratio 7.4, P<0.001).

Of these, there were 35 sudden cardiac deaths per 100,000 person-years among individuals with diabetes vs five sudden cardiac deaths per 100,000 person-years among those without diabetes (mortality risk ratio 4.6, P<0.001).

Most sudden cardiac deaths in 1- to 35-year-olds were from cardiac arrhythmia, whereas most sudden cardiac deaths among 36- to 49-year-olds were from coronary artery disease.

The study highlights that diabetes has a "high impact on the heart" even in very young people, Svane said.

"We would like to do a follow-up study and try to create a risk model," he said.

The authors have no relevant financial disclosures.

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