Diabetes, glucose level, and risk of sudden cardiac death.
OBJECTIVE
The prevalence of diabetes mellitus in industrialized countries is rapidly increasing, and diabetes is suspected to carry a particular high risk for sudden cardiac death (SCD).


RESULTS
We conducted a population-based case-control study at Group Health Cooperative. Cases (n=2040) experienced out-of-hospital cardiac arrest due to heart disease between 1980 and 1994. Controls (n=3800) were a stratified random sample of enrollees. Diabetes status was classified into four exclusive groups: (i) no diabetes, (ii) borderline, (iii) diabetes without microvascular disease (retinopathy or proteinuria), and (iv) diabetes with microvascular disease. When compared with no diabetes, we observed progressively higher risk of SCD associated with borderline diabetes [Odds ratio (OR)=1.24 (0.98-1.57)], diabetes without microvascular disease [OR=1.73 (1.28-2.34)], and diabetes with microvascular disease [OR=2.66 (1.84-3.85)], after adjustment for potential confounders (P-value for trend <0.001). Higher glucose levels were also associated with the risk of SCD both in the absence and in the presence of microvascular disease. However, subjects with microvascular complications but with glucose level <7.7 mmol/L were not at significant increased risk of SCD.


CONCLUSIONS
These results emphasize the role of diabetes as a strong risk factor for SCD and outline the importance of glucose level at every stage of diabetes severity.
Jouven
Xavier
X
Service de Cardiologie, Université Paris-5, Faculté René Descartes, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France. xavier.jouven@egp.ap-hop-paris.fr
Lemaître
Rozenn N
RN
Rea
Thomas D
TD
Sotoodehnia
Nona
N
Empana
Jean-Philippe
JP
Siscovick
David S
DS
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D016022:Case-Control Studies; D003327:Coronary Disease / Q000209:etiology / Q000378:metabolism; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D003925:Diabetic Angiopathies / Q000209:etiology* / Q000378:metabolism; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000378:metabolism; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D012307:Risk Factors
D001786:Blood Glucose