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Major abnormalities on ECG tied to CVD risk in type 1 diabetes
Major abnormalities on an electrocardiogram may be useful for predicting the development of cardiovascular disease in adults with type 1 diabetes, according to findings published in Diabetes Care.
Elsayed Z. Soliman, MD, of the Epidemiological Cardiology Research Center, department of epidemiology and prevention and department of medicine, section on cardiology, at Wake Forest School of Medicine in Winston-Salem, North Carolina, and colleagues evaluated data from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study on 1,306 adults (mean age, 35.5 years) with type 1 diabetes to determine the prevalence and incidence of ECG abnormalities with the development of CVD. Follow-up was a median of 19 years.
The Minnesota Code ECG classification was used to define ECG abnormalities as major, minor or none. First occurrence of myocardial infarction, stroke, confirmed angina, coronary artery revascularization, congestive heart failure or death from any CVD were used to define CVD events.
Through follow-up, 11.9% of participants developed CVD events for an incidence of 46.8 per 10,000 person-years. Most events were nonfatal (n = 148) and included 34 participants with clinical MI, 38 with silent MI, 16 with confirmed angina pectoris, 39 with coronary revascularization, three with congestive heart failure and 18 with stroke. Seven events were fatal and included two participants with sudden death.
The risk for a CVD event was increased more than 2.5 times with the presence of any major ECG abnormality compared with no abnormality/normal ECG (HR = 2.67; 95% CI, 1.62-4.4) or no major abnormality (HR = 2.57; 95% CI, 1.72-3.84). In the fully adjusted model, each visit (year) in which a diagnosis of a major ECG abnormality was obtained increased the risk for CVD by 30% (HR = 1.3; 95% CI, 1.14-1.48).
“The presence of major ECG abnormalities during the course of type 1 diabetes is associated with an increased risk of CVD events,” the researchers wrote. “Identifying risk markers/predictors such as ECG abnormalities in type 1 diabetes could help guide future efforts toward the development of risk stratification tools to identify those who may benefit from closer follow-up and earlier, more aggressive risk factor management.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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While ECG screening is generally not widely recommended for populations at large, a targeted approach in this population may be very effective. Guidelines from the American College of Cardiology and Heart Association state “CLASS IIa — A resting electrocardiogram is reasonable for cardiovascular risk assessment in asymptomatic adults with hypertension or diabetes” (Greenland P, et al. J Am Coll Cardiol. 2010;doi:10.1016/j.jacc.2010.09.001.) While a lot of studies have been done in patients with type 2 diabetes, the EDIC study sheds important light on the utility of ECG testing in asymptomatic persons with type 1 diabetes, a population much less studied than type 2 for CVD risk. The authors make a good case for additional screening and CVD care in those patients found to have abnormal ECG.
The prevalence of silent infarctions and asymptomatic disease is concerning, and the low cost and noninvasive nature of ECG testing makes this an ideal approach.