573225 research-article2015
DVR0010.1177/1479164115573225Diabetes & Vascular Disease ResearchWalker and Cubbon
Feature Article
Sudden cardiac death in patients with diabetes mellitus and chronic heart failure
Diabetes & Vascular Disease Research 2015, Vol. 12(4) 228–233 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1479164115573225 dvr.sagepub.com
Andrew MN Walker and Richard M Cubbon
Abstract In patients with diabetes mellitus, around 50% of deaths due to cardiovascular causes are sudden cardiac deaths. The prevalence of diabetes in cohorts with chronic heart failure is increasing, and while sudden cardiac death is an increasingly rare mode of death in chronic heart failure patients as a whole, the risk of this outcome remains high in those with diabetes. This review summarises the current knowledge on the incidence of sudden cardiac death in patients with diabetes and chronic heart failure, before discussing the causes of the excess risk seen in those with these coexistent conditions. We then describe current strategies for risk stratification and prevention of sudden cardiac death in these patients before discussing the priorities for further study in this area. Keywords Sudden cardiac death, diabetes, chronic heart failure, incidence, mortality
Introduction The increasing prevalence of diabetes mellitus (DM) is a major global public health concern. The 2013 International Diabetes Federation Diabetes Atlas estimates 382 million sufferers worldwide, resulting in estimated health care expenditure of US$548 billion per annum. This is projected to soar to US$627 billion by 2035, as 592 million are expected to have the disease across the globe.1 DM is an established risk factor for heart disease, and doubles the risk of cardiovascular morbidity and mortality. Indeed, 70% of patients with diabetes die from a cardiovascular cause, of which around 50% are sudden cardiac deaths (SCDs).2 Furthermore, despite diabetes having a prevalence of just below 10% in the European adult population, around 30% of those with chronic heart failure (CHF) have the condition. An adverse cardiovascular outlook is seen even in the early stages of the development of the disease, with prediabetes widely recognised as being a non-benign condition. Indeed, a recent UK registry study quoted the prevalence of prediabetes at 35% in 2011, a more than 200% increase since 2003.3 Given the growing numbers of those affected by dysglycaemia and cardiovascular disease, it is imperative that we accurately understand the risk of outcomes such as SCD in these individuals. This review will summarise current knowledge of the incidence of SCD in patients with diabetes and heart failure and then discuss the pathophysiological causes of this outcome. We will then examine current risk stratification
strategies before focussing on treatment options to prevent such events. We will conclude by highlighting important areas for further research to identify and treat those at risk of SCD.
The scale of the problem SCD is defined as that which occurs within 1 hour of a change in symptoms, during sleep or while the patient is unobserved.4,5 Established risk factors for SCD include previous myocardial infarction (MI), systolic heart failure with a left ventricular ejection fraction (LVEF) 35%) was
nearly identical to that found in patients without diabetes with LVEF ⩽ 35%: 4.1% (22/533) versus 4.9% (12/244). Given that thresholds for primary prevention of SCD with device therapies focus on those with a LVEF
DVR0010.1177/1479164115573225Diabetes & Vascular Disease ResearchWalker and Cubbon
Feature Article
Sudden cardiac death in patients with diabetes mellitus and chronic heart failure
Diabetes & Vascular Disease Research 2015, Vol. 12(4) 228–233 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1479164115573225 dvr.sagepub.com
Andrew MN Walker and Richard M Cubbon
Abstract In patients with diabetes mellitus, around 50% of deaths due to cardiovascular causes are sudden cardiac deaths. The prevalence of diabetes in cohorts with chronic heart failure is increasing, and while sudden cardiac death is an increasingly rare mode of death in chronic heart failure patients as a whole, the risk of this outcome remains high in those with diabetes. This review summarises the current knowledge on the incidence of sudden cardiac death in patients with diabetes and chronic heart failure, before discussing the causes of the excess risk seen in those with these coexistent conditions. We then describe current strategies for risk stratification and prevention of sudden cardiac death in these patients before discussing the priorities for further study in this area. Keywords Sudden cardiac death, diabetes, chronic heart failure, incidence, mortality
Introduction The increasing prevalence of diabetes mellitus (DM) is a major global public health concern. The 2013 International Diabetes Federation Diabetes Atlas estimates 382 million sufferers worldwide, resulting in estimated health care expenditure of US$548 billion per annum. This is projected to soar to US$627 billion by 2035, as 592 million are expected to have the disease across the globe.1 DM is an established risk factor for heart disease, and doubles the risk of cardiovascular morbidity and mortality. Indeed, 70% of patients with diabetes die from a cardiovascular cause, of which around 50% are sudden cardiac deaths (SCDs).2 Furthermore, despite diabetes having a prevalence of just below 10% in the European adult population, around 30% of those with chronic heart failure (CHF) have the condition. An adverse cardiovascular outlook is seen even in the early stages of the development of the disease, with prediabetes widely recognised as being a non-benign condition. Indeed, a recent UK registry study quoted the prevalence of prediabetes at 35% in 2011, a more than 200% increase since 2003.3 Given the growing numbers of those affected by dysglycaemia and cardiovascular disease, it is imperative that we accurately understand the risk of outcomes such as SCD in these individuals. This review will summarise current knowledge of the incidence of SCD in patients with diabetes and heart failure and then discuss the pathophysiological causes of this outcome. We will then examine current risk stratification
strategies before focussing on treatment options to prevent such events. We will conclude by highlighting important areas for further research to identify and treat those at risk of SCD.
The scale of the problem SCD is defined as that which occurs within 1 hour of a change in symptoms, during sleep or while the patient is unobserved.4,5 Established risk factors for SCD include previous myocardial infarction (MI), systolic heart failure with a left ventricular ejection fraction (LVEF) 35%) was
nearly identical to that found in patients without diabetes with LVEF ⩽ 35%: 4.1% (22/533) versus 4.9% (12/244). Given that thresholds for primary prevention of SCD with device therapies focus on those with a LVEF
