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Type 2 diabetes increased risk for sudden cardiac death in patients after MI

Junttila M. Heart Rhythm. 2010;7:1396 -1403.

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Patients with type 2 diabetes may be at a higher risk for sudden cardiac death after MI than nondiabetic patients, new data from Hearth Rhythm suggests.

“Type 2 diabetes mellitus is a well-established risk factor for atherosclerosis, but its contribution to sudden cardiac death risk after MI is not well defined,” the researchers wrote. “Sudden cardiac death in the post-MI patient is of special interest because of the magnitude of risk, the challenge of individual risk profiling and the potential for prevention in high-risk individuals.”

The study included 3,276 patients (mean age, 60 ± 11 years) who were enrolled at the time of acute MI between 1996 and 2005, and they were followed until 2009. At baseline, 629 patients (19.2%) had type 2 diabetes based upon WHO criteria. Patients with type 1 diabetes and patients with cardiac arrest during or before MI were excluded from the study.

Among patients with type 2 diabetes, rate of sudden cardiac death was notably higher than for nondiabetic patients (5.9% vs. 1.7%; adjusted HR=2.3; 95% CI, 1.4-3.8). The incidence of sudden cardiac death in diabetic patients with left ventricular ejection fraction of more than 35% was nearly identical to nondiabetic patients with LVEF of 35% or less (4.1% vs. 4.9%; P=.48).

Researchers also noted that an excess in the incidence of non-sudden cardiac death among diabetic patients started to appear within the first 6 months of follow-up (P<.001). This was not the case for both the incidence and excess of sudden cardiac death for diabetic patients, which did not begin to appear until more than 6 months after the index event.

“Patients with type 2 diabetes are at higher risk for sudden cardiac death after MI than are nondiabetic patients. The incidence of sudden cardiac death in post-MI type 2 diabetic patients with LVEF >35% is equal to that of nondiabetic patients with LVEF <35%,” the researchers concluded. “Further prospective information on post-MI diabetic patients is needed to evaluate indications for, and efficacy of, implantable cardioverter defibrillators and other therapies for this higher-risk subgroup.”

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