LONDON – Data from a national study show that patients with either type of diabetes, particularly type 1 diabetes, have a higher chance of sudden cardiac death (SCD) in all age groups. The increased risk highlights the importance of improving risk stratification for these patients.
“We know that patients with diabetes have several risk factors for adverse cardiovascular events and cardiovascular disease …… Therefore, their disease involves multiple organs. As cardiologists, we need to understand [diabetes],” said Prof. Jacob Tfelt-Hansen of the Department of Forensic Medicine at the University of Copenhagen, Denmark, who presented the findings at the European Society of Cardiology (ESC) Congress 2024.
Tfelt-Hansen and his colleagues previously found that Danish people under the age of 50 with diabetes had a seven-fold increased risk of cardiac death compared to those without diabetes.
Their latest study presents findings on the burden of SCD in people with diabetes in the general population. The study also examined the extent to which people with type 1 and type 2 diabetes have a shorter life expectancy due to SCD.
Relative risk
The researchers used data from the 2010 Danish population (about 5.5 million people). They identified 6,851 cases of SCD and matched them to people with type 1 and type 2 diabetes based on prescription data. Finally, the researchers determined the number of years of life lost in each diagnostic group.
Of the patients who experienced SCD, 155 had type 1 diabetes, 1,055 had type 2 diabetes, and 5,641 had no diabetes at all.
The average age of patients with type 1 diabetes was 50 years, 57% were male, and 5.5% of cases had arrhythmia. For type 2 diabetes, the average age was 65 years, 52% were male, and 11% of cases had arrhythmia.
The prevalence of SCD was consistently higher in diabetic patients in all age groups (0-90 years) compared to the general population.
“Heart disease is more common in people with diabetes than in the general population, but other conditions are also more common. For example, the prevalence of chronic kidney disease was 0.6% in the general population, 12.0% in the type 1 diabetes population, and 5.9% in the type 2 diabetes population,” Tfelt-Hansen said. The prevalence of lung and neurological diseases was also higher in the diabetic population.
Tfelt-Hansen explained that incidence rates per 100,000 person-years indicate that people with type 1 diabetes have a higher risk of SCD compared with the general population at all ages up to age 90 years, and SCD-specific incidence ratios by age group indicate a nearly 10-fold increase in risk at ≤30 years of age and a 20-fold increase in relative risk at 30-40 years of age (95% CI, 11.8-80.0), followed by an increase in risk with age. -80.0), and then decreases with age up to age 90 years.
People with type 2 diabetes had a nearly 6-fold increase in relative risk in the age group up to age 30, a 5.6-fold increase in relative risk at age 30-40 (95% CI, 2.7-14.0), and a decrease in relative risk up to age 90.
The study found that the total number of life years lost from all causes at age 30 for people with type 1 diabetes was nearly 14 years, of which 3.8 years were due to SCD. “For type 2 diabetes, the number of years of life lost was less, totaling 6.1 years of life lost, of which 2.2 years were due to SCD,” he said.
Prevention and monitoring are key
“We can certainly prevent [SCD] by treating people with diabetes better, but we need to prevent type 2 diabetes first. As cardiologists, we have to step up our efforts to do that,” he emphasized, alluding to lifestyle factors.
“But once a patient has diabetes, we need to monitor for [heart-related] symptoms. We know that for other conditions, up to 50% of young people with SCD will experience symptoms such as syncope or angina.”
Elijah R. Behr, professor of cardiovascular medicine at St. George’s University Hospital in London, England, says the relative risk for people in their 30s and 40s with type 1 diabetes is up to 20 times higher. He asked cardiologists whether type 1 diabetes should be considered a risk factor for aggressive treatments, such as implantable cardioverter-defibrillator therapy.
Tfelt-Hansen replied that he did not think this case met the threshold for net benefit with an implantable cardioverter defibrillator. However, he agreed with Behr’s suggestion that wearable monitoring devices may be appropriate for 30- to 40-year-old patients with type 1 diabetes.