Type 2 Diabetes an Independent Risk Factor for Coronary Artery Disease

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Researchers aimed to elucidate the incidence of cardiac mortality in a lower risk population of patients with type 2 diabetes and coronary artery disease.
Researchers aimed to elucidate the incidence of cardiac mortality in a lower risk population of patients with type 2 diabetes and coronary artery disease.

According to study results published in Heart Rhythm Society, type 2 diabetes (T2D) is an independent risk factor for sudden cardiac arrest and death in patients with coronary artery disease (CAD) with preserved ejection fraction.

With this prospective observational study, researchers sought to compare the incidence of sudden cardiac death in Finnish patients with and without T2D who had CAD and preserved ejection fraction. For a mean follow-up duration of 6.3 years, the investigators followed 834 patients with T2D and 1112 patients without diabetes, all of whom had CAD (median age, 67).

Compared with patients without diabetes, patients with T2D had a higher average baseline body mass index (27 kg/m2 vs 30 kg/m2, respectively; P <.001), heart rate, blood pressure, and left ventricular mass index. Left ventricular ejection fraction was also significantly lower in patients with T2D.

Of the total population, 50 patients experienced sudden cardiac death or arrest; this outcome was more frequent in patients with T2D than patients without diabetes (4.1% vs 1.4%, respectively; P <.001). However, the researchers concluded that the risk for nonsudden cardiac death was not significantly different between groups after adjustment for significant clinical factors.

There were 53 hospitalizations for heart failure in patients with T2D compared with 25 hospitalizations in patients without diabetes. In addition, annual cardiac mortality in patients without diabetes with CAD was 0.50%, a rate lower than that in the general Finnish population (0.59%).

The researchers noted the adjudication of sudden cardiac death as one possible limitation of their study.

“The fact that the majority of deaths in low-risk [patients with coronary artery disease] occur in the [type 2 diabetes] subgroup, with the [patients without diabetes with coronary artery disease] actually at no higher risk [for] cardiac death (or perhaps even lower) than is the general population in the same age range in the present era, suggests a pathophysiologically unique role for [type 2 diabetes] for multiple expressions of cardiovascular disease,” concluded the researchers.

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Reference

Junttila MJ, Kiviniemi AM, Lepojärvi ES, et al. Type 2 diabetes and coronary artery disease: Preserved ejection fraction and sudden cardiac death [published online October 4, 2018]. Heart Rhythm Society. doi:10.1016/j.hrthm.2018.06.017

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