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Sudden cardiac death in diabetes mellitus: risk factors in the Rochester diabetic neuropathy study
  1. G A Suarez1,
  2. V M Clark1,
  3. J E Norell1,
  4. T E Kottke2,
  5. M J Callahan2,
  6. P C O’Brien3,
  7. P A Low1,
  8. P J Dyck1
  1. 1Peripheral Neuropathy Research Laboratory, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, Minnesota, USA
  2. 2Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic College of Medicine and Mayo Foundation
  3. 3Division of Biostatistics, Mayo Clinic College of Medicine and Mayo Foundation
  1. Correspondence to:
 Dr Guillermo A Suarez
 Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA; suarez.guillermomayo.edu

Abstract

Objectives: To determine risk factors for sudden cardiac death and the role of diabetic autonomic neuropathy (DAN) in the Rochester diabetic neuropathy study (RDNS)

Methods: Associations between diabetic and cardiovascular complications, including DAN, and the risk of sudden cardiac death were studied among 462 diabetic patients (151 type 1) enrolled in the RDNS. Medical records, death certificates, and necropsy reports were assessed for causes of sudden cardiac death.

Results: 21 cases of sudden cardiac death were identified over 15 years of follow up. In bivariate analysis of risk covariates, the following were significant: ECG 1 (evolving and previous myocardial infarctions): hazard ratio (HR) = 4.4 (95% confidence interval (CI), 1.6 to 12.1), p = 0.004; ECG 2 (bundle branch block or pacing): HR = 8.6 (2.9 to 25.4), p<0.001; ECG 1 or ECG 2: HR = 4.2 (1.3 to 13.4), p = 0.014; and nephropathy stage: HR = 2.1 (1.3 to 3.4), p = 0.002. Adjusting for ECG 1 or ECG 2, autonomic scores, QTc interval, high density lipoprotein (HDL) cholesterol, 24 hour microalbuminuria, and 24 hour total proteinuria were significant. However, adjusting for nephropathy, none of the autonomic indices, QTc interval, HDL cholesterol, microalbuminuria, or total proteinuria was significant. At necropsy, all patients with sudden cardiac death had coronary artery or myocardial disease.

Conclusions: Sudden cardiac death was correlated with atherosclerotic heart disease and nephropathy, and to a lesser degree with DAN and HDL cholesterol. Although DAN is associated with sudden cardiac death, it is unlikely to be its primary cause.

  • CASS, composite autonomic severity scale
  • DAN, diabetic autonomic neuropathy
  • NIS, neuropathy impairment score
  • NSC, neuropathy symptoms and change score
  • QSART, quantitative sudomotor axon reflex test
  • RDNS, Rochester diabetic neuropathy study
  • sudden cardiac death
  • diabetic autonomic neuropathy
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Footnotes

  • Competing interests: none declared

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