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Diabetes mellitus and the risk of sudden cardiac death: A systematic review and meta-analysis of prospective studies

  • D. Aune
    Correspondence
    Corresponding author. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London W2 1PG, UK. Fax: +44(0) 20 7594. 0768.
    Affiliations
    Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom

    Bjørknes University College, Oslo, Norway

    Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
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  • S. Schlesinger
    Affiliations
    Institute for Biometry and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Germany
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  • T. Norat
    Affiliations
    Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
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  • E. Riboli
    Affiliations
    Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
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Published:February 24, 2018DOI:https://doi.org/10.1016/j.numecd.2018.02.011

      Highlights

      • Data regarding diabetes mellitus and sudden cardiac death is not as extensive as for myocardial infarction.
      • A meta-analysis was conducted of 19 population-based studies and 10 patient-based studies.
      • Diabetes mellitus was associated with a 2-fold increase in the risk of sudden cardiac death in the general population.
      • Diabetes mellitus was associated with a 75% increase in the risk of sudden cardiac death in the patient-based studies.
      • Pre-diabetes was associated with a 23% increase in the risk.

      Abstract

      Background

      Although diabetes mellitus is an established risk factor for myocardial infarction and stroke, data on the association with sudden cardiac death are less extensive and the findings have not been entirely consistent. We therefore conducted a systematic review and meta-analysis of prospective studies on diabetes mellitus and risk of sudden cardiac death.

      Methods and results

      PubMed and Embase databases were searched up to July 18th 2017. Prospective studies that reported adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) for the association between a diabetes diagnosis or pre-diabetes and risk of sudden cardiac death were included. Summary RRs were estimated by use of a random effects model. Nineteen population-based prospective studies (11 publications) (3610 cases, 249,225 participants) and 10 patient-based prospective studies (2713 cases, 55,098 participants) were included. The summary RR for diabetes patients vs. persons without diabetes was 2.02 (95% CI: 1.81–2.25, I2 = 0%, pheterogeneity = 0.91) in the population-based studies. The summary RR was 1.23 (95% CI: 1.05–1.44, I2 = 6%, pheterogeneity = 0.34) for the association between pre-diabetes and sudden cardiac death (n = 3 studies, 1000 sudden cardiac deaths, 18,360 participants). In the patient-based studies, the summary RR of sudden cardiac death for diabetes patients vs. patients without diabetes was 1.75 (95% CI: 1.51–2.03, I2 = 39%, pheterogeneity = 0.10) for all patients combined, 1.63 (95% CI: 1.36–1.97, I2 = 39%, n = 5) for coronary heart disease patients, and 1.85 (95% CI: 1.48–2.33, I2 = 0%, n = 3) for heart failure patients.

      Conclusions

      These results suggest that diabetes patients are at an increased risk of sudden cardiac death both in the general population and among different patient groups.

      Keywords

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      References

        • NCD Risk Factor Collaboration (NCD-RisC)
        Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants.
        Lancet. 2016; 387: 1513-1530
        • Campbell P.T.
        • Newton C.C.
        • Patel A.V.
        • Jacobs E.J.
        • Gapstur S.M.
        Diabetes and cause-specific mortality in a prospective cohort of one million U.S. adults.
        Diabetes Care. 2012; 35: 1835-1844
        • Aune D.
        • Vatten L.J.
        Diabetes mellitus and the risk of gallbladder disease: a systematic review and meta-analysis of prospective studies.
        J Diabet Complicat. 2016; 30: 368-373
        • Benjamin E.J.
        • Blaha M.J.
        • Chiuve S.E.
        • Cushman M.
        • Das S.R.
        • Deo R.
        • et al.
        Heart disease and stroke statistics-2017 update: a report from the american heart association.
        Circulation. 2017; 135: e146-e603
        • Wannamethee G.
        • Shaper A.G.
        • Macfarlane P.W.
        • Walker M.
        Risk factors for sudden cardiac death in middle-aged British men.
        Circulation. 1995; 91: 1749-1756
        • Jouven X.
        • Desnos M.
        • Guerot C.
        • Ducimetiere P.
        Predicting sudden death in the population: the Paris prospective study I.
        Circulation. 1999; 99: 1978-1983
        • Kataoka M.
        • Ito C.
        • Sasaki H.
        • Yamane K.
        • Kohno N.
        Low heart rate variability is a risk factor for sudden cardiac death in type 2 diabetes.
        Diabetes Res Clin Pract. 2004; 64: 51-58
        • Straus S.M.
        • Kors J.A.
        • De Bruin M.L.
        • van der Hooft C.S.
        • Hofman A.
        • Heeringa J.
        • et al.
        Prolonged QTc interval and risk of sudden cardiac death in a population of older adults.
        J Am Coll Cardiol. 2006; 47: 362-367
        • Ohira T.
        • Maruyama M.
        • Imano H.
        • Kitamura A.
        • Kiyama M.
        • Okada T.
        • et al.
        Risk factors for sudden cardiac death among Japanese: the Circulatory Risk in Communities Study.
        J Hypertens. 2012; 30: 1137-1143
        • Bertoia M.L.
        • Allison M.A.
        • Manson J.E.
        • Freiberg M.S.
        • Kuller L.H.
        • Solomon A.J.
        • et al.
        Risk factors for sudden cardiac death in post-menopausal women.
        J Am Coll Cardiol. 2012; 60: 2674-2682
        • Lahtinen A.M.
        • Noseworthy P.A.
        • Havulinna A.S.
        • Jula A.
        • Karhunen P.J.
        • Kettunen J.
        • et al.
        Common genetic variants associated with sudden cardiac death: the FinSCDgen study.
        PLoS One. 2012; 7 (e41675)
        • Laukkanen J.A.
        • Makikallio T.H.
        • Ronkainen K.
        • Karppi J.
        • Kurl S.
        Impaired fasting plasma glucose and type 2 diabetes are related to the risk of out-of-hospital sudden cardiac death and all-cause mortality.
        Diabetes Care. 2013; 36: 1166-1171
        • Eranti A.
        • Kerola T.
        • Aro A.L.
        • Tikkanen J.T.
        • Rissanen H.A.
        • Anttonen O.
        • et al.
        Diabetes, glucose tolerance, and the risk of sudden cardiac death.
        BMC Cardiovasc Disord. 2016; 16: 51
        • Waks J.W.
        • Sitlani C.M.
        • Soliman E.Z.
        • Kabir M.
        • Ghafoori E.
        • Biggs M.L.
        • et al.
        Global electric heterogeneity risk score for prediction of sudden cardiac death in the general population: the atherosclerosis risk in communities (ARIC) and cardiovascular health (CHS) studies.
        Circulation. 2016; 133: 2222-2234
        • Patel R.B.
        • Moorthy M.V.
        • Chiuve S.E.
        • Pradhan A.D.
        • Cook N.R.
        • Albert C.M.
        Hemoglobin A1c levels and risk of sudden cardiac death: a nested case-control study.
        Heart Rhythm. 2017; 14: 72-78
        • Zaccardi F.
        • Khan H.
        • Laukkanen J.A.
        Diabetes mellitus and risk of sudden cardiac death: a systematic review and meta-analysis.
        Int J Cardiol. 2014; 177: 535-537
        • Atwater B.D.
        • Thompson V.P.
        • Vest III, R.N.
        • Shaw L.K.
        • Mazzei Jr., W.R.
        • Al-Khatib S.M.
        • et al.
        Usefulness of the duke sudden cardiac death risk score for predicting sudden cardiac death in patients with angiographic (>75% narrowing) coronary artery disease.
        Am J Cardiol. 2009; 104: 1624-1630
        • Junttila M.J.
        • Barthel P.
        • Myerburg R.J.
        • Makikallio T.H.
        • Bauer A.
        • Ulm K.
        • et al.
        Sudden cardiac death after myocardial infarction in patients with type 2 diabetes.
        Heart Rhythm. 2010; 7: 1396-1403
        • Deo R.
        • Vittinghoff E.
        • Lin F.
        • Tseng Z.H.
        • Hulley S.B.
        • Shlipak M.G.
        Risk factor and prediction modeling for sudden cardiac death in women with coronary artery disease.
        Arch Intern Med. 2011; 171: 1703-1709
        • Yeung C.Y.
        • Lam K.S.
        • Li S.W.
        • Lam K.F.
        • Tse H.F.
        • Siu C.W.
        Sudden cardiac death after myocardial infarction in type 2 diabetic patients with no residual myocardial ischemia.
        Diabetes Care. 2012; 35: 2564-2569
        • Andersson J.
        • Wennberg P.
        • Lundblad D.
        • Escher S.A.
        • Jansson J.H.
        Diabetes mellitus, high BMI and low education level predict sudden cardiac death within 24 hours of incident myocardial infarction.
        Eur J Prev Cardiol. 2016; 23: 1814-1820
        • Hagens V.E.
        • Rienstra M.
        • van Veldhuisen D.J.
        • Crijns H.J.
        • Van G.I.
        Determinants of sudden cardiac death in patients with persistent atrial fibrillation in the rate control versus electrical cardioversion (RACE) study.
        Am J Cardiol. 2006; 98: 929-932
        • Al-Khatib S.M.
        • Shaw L.K.
        • O'Connor C.
        • Kong M.
        • Califf R.M.
        Incidence and predictors of sudden cardiac death in patients with diastolic heart failure.
        J Cardiovasc Electrophysiol. 2007; 18: 1231-1235
        • Bayes-Genis A.
        • Vazquez R.
        • Puig T.
        • Fernandez-Palomeque C.
        • Fabregat J.
        • Bardaji A.
        • et al.
        Left atrial enlargement and NT-proBNP as predictors of sudden cardiac death in patients with heart failure.
        Eur J Heart Fail. 2007; 9: 802-807
        • Adabag S.
        • Rector T.S.
        • Anand I.S.
        • McMurray J.J.
        • Zile M.
        • Komajda M.
        • et al.
        A prediction model for sudden cardiac death in patients with heart failure and preserved ejection fraction.
        Eur J Heart Fail. 2014; 16: 1175-1182
        • Shastri S.
        • Tangri N.
        • Tighiouart H.
        • Beck G.J.
        • Vlagopoulos P.
        • Ornt D.
        • et al.
        Predictors of sudden cardiac death: a competing risk approach in the hemodialysis study.
        Clin J Am Soc Nephrol. 2012; 7: 123-130
        • Stroup D.F.
        • Berlin J.A.
        • Morton S.C.
        • Olkin I.
        • Williamson G.D.
        • Rennie D.
        • et al.
        Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group.
        J Am Med Assoc. 2000; 283: 2008-2012
        • DerSimonian R.
        • Laird N.
        Meta-analysis in clinical trials.
        Control Clin Trials. 1986; 7: 177-188
        • Higgins J.P.
        • Thompson S.G.
        Quantifying heterogeneity in a meta-analysis.
        Stat Med. 2002; 21: 1539-1558
      1. Wells G, Shea B, O'Connell D., Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp, Accessed 17.08.2017.

        • Egger M.
        • Davey S.G.
        • Schneider M.
        • Minder C.
        Bias in meta-analysis detected by a simple, graphical test.
        BMJ. 1997; 315: 629-634
        • Begg C.B.
        • Mazumdar M.
        Operating characteristics of a rank correlation test for publication bias.
        Biometrics. 1994; 50: 1088-1101
        • Duval S.
        • Tweedie R.
        Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis.
        Biometrics. 2000; 56: 455-463
        • Kucharska-Newton A.M.
        • Couper D.J.
        • Pankow J.S.
        • Prineas R.J.
        • Rea T.D.
        • Sotoodehnia N.
        • et al.
        Diabetes and the risk of sudden cardiac death, the Atherosclerosis Risk in Communities study.
        Acta Diabetol. 2010; 47: 161-168
        • Albert C.M.
        • Chae C.U.
        • Grodstein F.
        • Rose L.M.
        • Rexrode K.M.
        • Ruskin J.N.
        • et al.
        Prospective study of sudden cardiac death among women in the United States.
        Circulation. 2003; 107: 2096-2101
        • Khosravi A.
        • Gharipour M.
        • Nezafati P.
        • Khosravi Z.
        • Sadeghi M.
        • Khaledifar A.
        • et al.
        Pre-hypertension, pre-diabetes or both: which is best at predicting cardiovascular events in the long term?.
        J Hum Hypertens. 2017; 31: 382-387
        • Shah A.D.
        • Langenberg C.
        • Rapsomaniki E.
        • Denaxas S.
        • Pujades-Rodriguez M.
        • Gale C.P.
        • et al.
        Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1.9 million people.
        Lancet Diabetes Endocrinol. 2015; 3: 105-113
        • Chao T.F.
        • Liu C.J.
        • Tuan T.C.
        • Chen S.J.
        • Chen T.J.
        • Lip G.Y.H.
        • et al.
        Risk and prediction of sudden cardiac death and ventricular arrhythmias for patients with atrial fibrillation-a nationwide cohort study.
        Sci Rep. 2017; 7: 46445
        • Ouellet G.
        • Moss A.J.
        • Jons C.
        • McNitt S.
        • Mullally J.
        • Fugate T.
        • et al.
        Influence of diabetes mellitus on outcome in patients over 40 years of age with the long QT syndrome.
        Am J Cardiol. 2010; 105: 87-89
        • Alonso A.
        • Krijthe B.P.
        • Aspelund T.
        • Stepas K.A.
        • Pencina M.J.
        • Moser C.B.
        • et al.
        Simple risk model predicts incidence of atrial fibrillation in a racially and geographically diverse population: the CHARGE-AF consortium.
        J Am Heart Assoc. 2013; 2: 2000102
        • Spallone V.
        • Ziegler D.
        • Freeman R.
        • Bernardi L.
        • Frontoni S.
        • Pop-Busui R.
        • et al.
        Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management.
        Diabetes Metab Res Rev. 2011; 27: 639-653
        • Singh J.P.
        • Larson M.G.
        • O'Donnell C.J.
        • Wilson P.F.
        • Tsuji H.
        • Lloyd-Jones D.M.
        • et al.
        Association of hyperglycemia with reduced heart rate variability (The Framingham Heart Study).
        Am J Cardiol. 2000; 86: 309-312
        • Ewing D.J.
        • Boland O.
        • Neilson J.M.
        • Cho C.G.
        • Clarke B.F.
        Autonomic neuropathy, QT interval lengthening, and unexpected deaths in male diabetic patients.
        Diabetologia. 1991; 34: 182-185
        • Chugh S.S.
        • Kelly K.L.
        • Titus J.L.
        Sudden cardiac death with apparently normal heart.
        Circulation. 2000; 102: 649-654
        • Farb A.
        • Tang A.L.
        • Burke A.P.
        • Sessums L.
        • Liang Y.
        • Virmani R.
        Sudden coronary death. Frequency of active coronary lesions, inactive coronary lesions, and myocardial infarction.
        Circulation. 1995; 92: 1701-1709