A recent study published in the European Heart Journal reports that people with both type 1 and type 2 diabetes face a higher risk of sudden cardiac death, particularly among younger adults. The research, led by Dr Tobias Skjelbred from Copenhagen University Hospital, Rigshospitalet, Denmark, analyzed data from the entire Danish population in 2010.
Researchers examined all 54,028 deaths in Denmark during that year. Using death certificates, hospital discharge summaries, and autopsy reports, they identified 6,862 cases of sudden cardiac death. By cross-referencing these cases with records indicating whether individuals had type 1 diabetes, type 2 diabetes or neither condition, the team compared rates of sudden cardiac death across groups.
The findings showed that sudden cardiac death was 3.7 times more common among people with type 1 diabetes and 6.5 times more common for those with type 2 diabetes compared to the general population. The difference in risk was most significant among younger adults; individuals under age 50 with diabetes had a sevenfold increased risk.
The study also found that average life expectancy was reduced by over fourteen years for people with type 1 diabetes and nearly eight years for those with type 2 diabetes. Sudden cardiac death accounted for approximately three years of this reduction in both groups.
Dr Skjelbred stated: "We found that sudden cardiac death occurs more frequently in people with diabetes across all age groups, and that sudden cardiac death has a substantial impact on the shortened life expectancy in individuals with diabetes. While sudden cardiac death risk increases with age for everyone, the relative difference is most pronounced when comparing younger people with diabetes to their peers in the general population."
He added: "This is an observational study, meaning that we can see a link between diabetes and sudden cardiac death, but we cannot prove that one causes the other. Sudden cardiac death is challenging to predict and prevent, but these findings reinforce the importance for people with diabetes to work with their clinicians to reduce cardiovascular risk."
According to Dr Skjelbred: "There are probably several reasons behind this link, and these may differ by age. Having diabetes predisposes people to ischaemic heart disease, which is a key mechanism. In addition, diabetes-specific factors such as hypoglycaemia and cardiac autonomic neuropathy may increase the chances of an irregular heartbeat and sudden cardiac death."
He noted a limitation: "A key limitation of this study is that it focuses on deaths in 2010, before widespread use of newer glucose-lowering therapies such as SGLT2 inhibitors and GLP-1 receptor agonists. We therefore cannot assess how these treatments may have influenced sudden cardiac death in more recent years."
The researchers suggest future efforts could focus on identifying subgroups within the diabetic population who might benefit from preventive strategies such as implantable cardioverter-defibrillators.
In an editorial accompanying the publication, Dr Hanno Tan from Amsterdam UMC commented: "Despite significant advances in cardiovascular medicine, sudden cardiac death (SCD) remains a challenge for prevention and treatment due to its unpredictable nature and high fatality rate."
Dr Tan continued: "Previous studies have indicated that the incidence of sudden cardiac arrest (SCA) in diabetics is elevated compared to the general population."
He further stated: "In this issue of the European Heart Journal, Skjelbred et al expand upon these previous studies, furthering our understanding of the relationship between diabetes and SCD. For the first time, the extent of both loss in life expectancy due to diabetes and the contribution of SCD to this loss is quantified."
"Of particular interest is the finding that the diabetes-associated risk of SCD was higher among younger individuals than among older individuals. For example, the incidence rate was highest in the 30-40 year age group among type 1 diabetes patients (22.7), and in the 40-50 year age group among type 2 diabetes patients (6.0)."
Dr Tan also highlighted new technologies: "[…] studies have been initiated to develop systems that may autonomously detect SCA and call the emergency number e.g., through use of wearables such as smartwatches. Such solutions may have particular relevance for type 1 diabetes patients because proportion of unwitnessed SCA events is higher in these patients than general population. Thus type 1 diabetes patients may derive particular benefit from these solutions."
He concluded: "[…] we may be able to reduce burden of SCD in diabetes patients with use personalized treatment interventions aim at preventing SCA improving SCA treatment."
