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Type 2 diabetes mellitus and the risk of sudden cardiac arrest in the community

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Abstract

The reduction of mortality from sudden cardiac arrest (SCA) in the setting of coronary heart disease (CHD) remains a major challenge, especially among patients with type 2 diabetes. Diabetes is associated with an increased risk of SCA, at least in part, from an increased presence and extent of coronary atherosclerosis (macrovascular disease). Diabetes also is associated with microvascular disease and autonomic neuropathy; and, these non-coronary atherosclerotic pathophysiologic processes also have the potential to increase the risk of SCA. In this report, we review the absolute and relative risk of SCA associated with diabetes. We summarize recent evidence that suggests that the increase in risk in patients with diabetes is not specific for SCA, as diabetes also is associated with a similar increase in risk for non-SCA CHD death and non-fatal myocardial infarction. These data are consistent with prior observations that coronary atherosclerosis is a major contributor to the increased SCA risk associated with diabetes. We also present previously published and unpublished data that demonstrates that both clinically-recognized microvascular and autonomic neuropathy also are associated with the risk of SCA among treated patients with diabetes, after taking into account prior clinically-recognized heart disease and other risk factors for SCA. We then discuss how these data might inform research and clinical efforts to prevent SCA. Although the prediction of SCA in this “high” risk population is likely to remain a challenge, as it is in other “high” risk clinical populations, we suggest that current recommendations for the prevention of SCA in the community, related to both lifestyle prescriptions and risk factor reduction, are likely to reduce mortality from SCA among patients with diabetes.

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Acknowledgments

The research reported in this article was supported by the Seattle Medic One Foundation, Seattle, Washington, and grant R01 HL 42456 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.

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Authors and Affiliations

  1. Medicine and Epidemiology, University of Washington, Cardiovascular Health Research Unit, 1730 Minor Avenue, Seattle, WA, 98101, USA

    David S. Siscovick

  2. Medicine, University of Washington, Cardiovascular Health Research Unit, 1730 Minor Avenue, Seattle, WA, 98101, USA

    Nona Sotoodehnia, Thomas D. Rea & Rozenn N. Lemaitre

  3. University of Michigan, Institute for Social Research, Ann Arbor, MI, USA

    Trivellore E. Raghunathan

  4. INSERM, Unit 909, Hopital Européen Georges Pompidou, Paris, France

    Xavier Jouven

Authors
  1. David S. Siscovick
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  2. Nona Sotoodehnia
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  3. Thomas D. Rea
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  4. Trivellore E. Raghunathan
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  5. Xavier Jouven
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  6. Rozenn N. Lemaitre
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Correspondence to David S. Siscovick.

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Siscovick, D.S., Sotoodehnia, N., Rea, T.D. et al. Type 2 diabetes mellitus and the risk of sudden cardiac arrest in the community. Rev Endocr Metab Disord 11, 53–59 (2010). https://doi.org/10.1007/s11154-010-9133-5

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  • DOI: https://doi.org/10.1007/s11154-010-9133-5

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