A new nationwide study reveals that patients with diabetes, particularly those with type 1, face significantly higher rates of sudden cardiac death (SCD) across all age groups. The findings, which highlight the critical need for better risk assessment in these individuals, were presented at the European Society of Cardiology (ESC) Congress 2024.
“Diabetes patients are predisposed to various cardiovascular complications, which often involve multiple organ systems. As cardiologists, it is crucial that we remain vigilant about the heightened risks associated with diabetes,” said Professor Jacob Tfelt-Hansen from the University of Copenhagen’s Department of Forensic Medicine. He emphasized the importance of this awareness while presenting the study’s outcomes.
Increased Mortality Risk Among Young Diabetics
Tfelt-Hansen and his research team have previously identified a sevenfold increase in cardiac death risk among Danes under 50 with diabetes compared to non-diabetic individuals. The current study delves further, examining the burden of SCD among the diabetic population and evaluating the reduction in life expectancy due to SCD in both type 1 and type 2 diabetes.
Utilizing data from Denmark’s entire population in 2010, the researchers identified 6,851 cases of SCD, with 155 cases among type 1 diabetics, 1,055 in type 2 diabetics, and 5,641 in those without diabetes. The study matched these cases with diabetes diagnoses based on prescription data, further calculating the years of life lost in each group.
Findings indicated that the mean age at death for those with type 1 diabetes was 50 years, with 57% of the deceased being male and 5.5% presenting with arrhythmia. For type 2 diabetes, the average age was 65 years, with 52% being male and 11% having arrhythmia.
Across all age groups, individuals with diabetes exhibited consistently higher SCD rates compared to the general population.
Cardiovascular and Other Complications
“Cardiac disease is prevalent among diabetes patients, but other conditions, such as chronic kidney disease, are also significantly more common in these individuals compared to the general population. Chronic kidney disease affects 0.6% of the general population, compared to 12.0% of those with type 1 diabetes and 5.9% of those with type 2,” noted Tfelt-Hansen, adding that pulmonary and neurological conditions also showed increased incidence in diabetic populations.
The study’s data revealed that type 1 diabetes dramatically increased SCD risk, with incidence rates showing nearly a 10-fold increase for those aged 30 and younger, and a 20-fold increase for those between 30 and 40. Although the risk decreased with age, it remained elevated up to 90 years. Similarly, type 2 diabetes was associated with a nearly sixfold increase in SCD risk for those under 30, and a 5.6-fold increase for those aged 30-40, with the risk decreasing with age.
In terms of life expectancy, individuals with type 1 diabetes lost nearly 14 years by age 30, with SCD accounting for 3.8 of those years. For those with type 2 diabetes, the total life years lost by age 30 was 6.1, with 2.2 of those due to SCD.
The Need for Prevention and Monitoring
Tfelt-Hansen stressed the importance of preventive measures, particularly in managing type 2 diabetes. “Preventing SCD starts with better diabetes management and, ideally, preventing type 2 diabetes altogether. Cardiologists must take a proactive role in this,” he urged.
He also emphasized the need for monitoring heart-related symptoms in diabetic patients, particularly in younger individuals. “We know that up to 50% of young people who experience SCD show symptoms like syncope or angina beforehand,” he said.
Professor Elijah R. Behr of St George’s University Hospitals in London commented on the study’s findings, noting the “staggering” 20-fold increase in SCD risk among type 1 diabetics aged 30-40. He questioned whether this risk should prompt consideration of aggressive treatments, such as implantable cardioverter defibrillators (ICDs).
In response, Tfelt-Hansen stated that while ICD therapy might not provide a net benefit in these cases, he agreed that younger patients with type 1 diabetes could benefit from wearable monitoring devices to track heart-related symptoms.
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