Sudden cardiac death in diabetes mellitus: risk factors in the Rochester diabetic neuropathy study
Open accessAbstract
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.
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Diabetic autonomic neuropathy is associated with significant increases in morbidity and mortality, including an increased risk of sudden death.
“diabetic autonomic neuropathy is associated with significant increases in morbidity and mortality, including an increased risk of sudden death (37, 42, 43).”
From Effects of glucagon-like peptide-1, yohimbine, and nitrergic modulation on sympathetic and parasympathetic activity in humans (2008) · cites this paper as [43]
The Abstract concludes that diabetic autonomic neuropathy is associated with sudden cardiac death, though less strongly than heart disease or nephropathy and unlikely to be its primary cause. The paper does not establish the broader claim of significant increases in morbidity and mortality associated with diabetic autonomic neuropathy. (LLM, conf=0.88)
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- Authors
- Suarez, G. A.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Suarez, G A
- Venue
- Journal of Neurology, Neurosurgery & Psychiatry
- Publisher
- BMJ
- Published
- 2005-02-01
- Volume
- 76
- Issue
- 2
- Pages
- 240-245
- ISSN
- 0022-3050 (ISSN-L)
- PMC
- PMC1739480
- OpenAlex
- W2013177945
- Cited by
- 109
- References
- 44
- Citations by year
- 2026: 1 · 2024: 2 · 2023: 6 · 2022: 2 · 2021: 2 · 2020: 6 · 2019: 2 · 2018: 5 · 2017: 4 · 2016: 11 · 2015: 2 · 2014: 7 · 2013: 11 · 2012: 6
- FWCI
- 6.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Neurology Neurosurgery & Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Academy of Neurology
- Mayo Foundation for Medical Education and Research
- National Science Council
- U.S. Public Health Service (36797)
- National Institute of Neurological Disorders and Stroke
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- sudden cardiac death, diabetes mellitus, diabetic autonomic neuropathy, risk factors, myocardial infarction, bundle branch block, diabetic nephropathy, atherosclerotic heart disease, HDL cholesterol, microalbuminuria, proteinuria, QTc interval
- MeSH terms
- Aged, Arteriosclerosis, Cross-Sectional Studies, Diabetic Neuropathies, Female, Heart Diseases, Humans, Cholesterol, HDL, Longitudinal Studies, Male, Middle Aged, Risk Factors, Death, Sudden, Cardiac
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