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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Nutrition, Metabolism and Cardiovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants.Lancet. 2016; 387: 1513-1530
- Diabetes and cause-specific mortality in a prospective cohort of one million U.S. adults.Diabetes Care. 2012; 35: 1835-1844
- Diabetes mellitus and the risk of gallbladder disease: a systematic review and meta-analysis of prospective studies.J Diabet Complicat. 2016; 30: 368-373
- Heart disease and stroke statistics-2017 update: a report from the american heart association.Circulation. 2017; 135: e146-e603
- Risk factors for sudden cardiac death in middle-aged British men.Circulation. 1995; 91: 1749-1756
- Predicting sudden death in the population: the Paris prospective study I.Circulation. 1999; 99: 1978-1983
- Low heart rate variability is a risk factor for sudden cardiac death in type 2 diabetes.Diabetes Res Clin Pract. 2004; 64: 51-58
- Prolonged QTc interval and risk of sudden cardiac death in a population of older adults.J Am Coll Cardiol. 2006; 47: 362-367
- Risk factors for sudden cardiac death among Japanese: the Circulatory Risk in Communities Study.J Hypertens. 2012; 30: 1137-1143
- Risk factors for sudden cardiac death in post-menopausal women.J Am Coll Cardiol. 2012; 60: 2674-2682
- Common genetic variants associated with sudden cardiac death: the FinSCDgen study.PLoS One. 2012; 7 (e41675)
- 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
- Diabetes, glucose tolerance, and the risk of sudden cardiac death.BMC Cardiovasc Disord. 2016; 16: 51
- 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
- Hemoglobin A1c levels and risk of sudden cardiac death: a nested case-control study.Heart Rhythm. 2017; 14: 72-78
- Diabetes mellitus and risk of sudden cardiac death: a systematic review and meta-analysis.Int J Cardiol. 2014; 177: 535-537
- 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
- Sudden cardiac death after myocardial infarction in patients with type 2 diabetes.Heart Rhythm. 2010; 7: 1396-1403
- Risk factor and prediction modeling for sudden cardiac death in women with coronary artery disease.Arch Intern Med. 2011; 171: 1703-1709
- Sudden cardiac death after myocardial infarction in type 2 diabetic patients with no residual myocardial ischemia.Diabetes Care. 2012; 35: 2564-2569
- 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
- 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
- Incidence and predictors of sudden cardiac death in patients with diastolic heart failure.J Cardiovasc Electrophysiol. 2007; 18: 1231-1235
- 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
- A prediction model for sudden cardiac death in patients with heart failure and preserved ejection fraction.Eur J Heart Fail. 2014; 16: 1175-1182
- Predictors of sudden cardiac death: a competing risk approach in the hemodialysis study.Clin J Am Soc Nephrol. 2012; 7: 123-130
- 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
- Meta-analysis in clinical trials.Control Clin Trials. 1986; 7: 177-188
- Quantifying heterogeneity in a meta-analysis.Stat Med. 2002; 21: 1539-1558
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.
- Bias in meta-analysis detected by a simple, graphical test.BMJ. 1997; 315: 629-634
- Operating characteristics of a rank correlation test for publication bias.Biometrics. 1994; 50: 1088-1101
- Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis.Biometrics. 2000; 56: 455-463
- Diabetes and the risk of sudden cardiac death, the Atherosclerosis Risk in Communities study.Acta Diabetol. 2010; 47: 161-168
- Prospective study of sudden cardiac death among women in the United States.Circulation. 2003; 107: 2096-2101
- Pre-hypertension, pre-diabetes or both: which is best at predicting cardiovascular events in the long term?.J Hum Hypertens. 2017; 31: 382-387
- Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1.9 million people.Lancet Diabetes Endocrinol. 2015; 3: 105-113
- Risk and prediction of sudden cardiac death and ventricular arrhythmias for patients with atrial fibrillation-a nationwide cohort study.Sci Rep. 2017; 7: 46445
- 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
- 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
- Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management.Diabetes Metab Res Rev. 2011; 27: 639-653
- Association of hyperglycemia with reduced heart rate variability (The Framingham Heart Study).Am J Cardiol. 2000; 86: 309-312
- Autonomic neuropathy, QT interval lengthening, and unexpected deaths in male diabetic patients.Diabetologia. 1991; 34: 182-185
- Sudden cardiac death with apparently normal heart.Circulation. 2000; 102: 649-654
- Sudden coronary death. Frequency of active coronary lesions, inactive coronary lesions, and myocardial infarction.Circulation. 1995; 92: 1701-1709
Article info
Publication history
Published online: February 24, 2018
Accepted:
February 18,
2018
Received in revised form:
February 9,
2018
Received:
November 25,
2017
Handling Editor: A. GiaccariIdentification
Copyright
© 2018 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
