A recent study presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) has unveiled various factors associated with a heightened risk of sudden cardiac arrest (SCA) in individuals with type 2 diabetes (T2D).
SCA is a severe condition in which the heart suddenly stops pumping blood, responsible for a significant proportion of cardiac deaths and overall mortality in high-income countries.
People with T2D face a doubled risk of SCA, making it crucial to identify potential risk factors, especially among those without a history of cardiovascular disease (CVD).
Researchers, led by Peter Harms from Amsterdam UMC in the Netherlands, conducted a case-control study to pinpoint clinical characteristics linked to SCA in T2D patients, with or without prior CVD.
The study involved 3,919 individuals with T2D, comprising 689 cases of SCA and 3,230 controls.
Cases involved individuals who experienced SCA in the Dutch region of Noord-Holland between 2010 and 2019, matched by age, sex, and general practitioner (GP) practice with up to five non-SCA controls.
Data from GP records, including blood pressure and blood glucose measurements, medication usage, and medical history spanning five years leading up to SCA cases, were analyzed. Characteristics associated with an increased risk of SCA included:
In both groups (with and without CVD):
- History of arrhythmias (68% increase in SCA risk)
- Unknown smoking behavior (40% increase)
- Insulin use (138% increase)
- Use of QTc-prolonging prokinetic medications (66% increase)
QTc-prolonging medications include prokinetics like domperidone, antibiotics like macrolides and fluoroquinolones, and antipsychotics like haloperidol.
In those with CVD:
- Moderate (54% increase) and severe (55% increase) albuminuria
- Heart failure (85% increase)
In those without CVD:
- Low fasting glucose (150% increase, indicating overly strict blood sugar control)
- Severe systolic blood pressure (>180mmHg: 121% increase)
- Low HDL cholesterol (<1.0 mmol/l: 35% increase)
- High LDL cholesterol (>2.6 mmol/l: 64% increase)
- Use of QTc-prolonging antipsychotic (187% increase) and antibiotic medications (66% increase)
The study underscores the importance of general practitioners (GPs) being aware of various factors, including strict glycaemic control and the prescription of commonly used antibiotics, antipsychotics, and prokinetics, that may elevate the risk of SCA in T2D patients.
These findings aim to enhance risk assessment and management strategies for individuals with T2D, particularly those without prior cardiovascular disease.
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