title: Diabetes, glucose tolerance, and the risk of sudden cardiac death.
abstract: BACKGROUND
  Diabetes predisposes to sudden cardiac death (SCD). However, it is uncertain whether greater proportion of cardiac deaths are sudden among diabetes patients than other subjects. It is also unclear whether the risk of SCD is pronounced already early in the course of the disease. The relationship of impaired glucose tolerance (IGT) and SCD is scarcely documented.
  
  
  METHODS
  A general population cohort of 10594 middle-aged subjects (mean age 44 years, 52.6 % male, follow-up duration 35-41 years) was divided into diabetes patients (n = 82), subjects with IGT (n = 3806, plasma glucose ≥9.58 mmol/l in one-hour glucose tolerance test), and controls (n = 6706).
  
  
  RESULTS
  Diabetes patients had an increased risk of SCD after adjustment confounders (hazard ratio 2.62, 95 % confidence interval 1.46-4.70, p = 0.001) but risk for non-sudden cardiac death was similarly increased and the proportion of SCD of cardiac deaths was not increased. The SCD risk persisted after exclusion of subjects with baseline cardiac disease or non-fatal cardiac events during the follow-up. Subjects with IGT were at increased risk for SCD (univariate hazard ratio 1.51; 95 % confidence interval 1.31-1.74; p < 0.001) and also for non-sudden cardiac deaths and non-fatal cardiac events but adjustments for other risk factors attenuated these effects.
  
  
  CONCLUSIONS
  Diabetes was associated with increased risk of SCD but also the risk of non-sudden cardiac death was similarly increased. The proportion of cardiac deaths being sudden in subjects with diabetes was not increased. The higher SCD risk in diabetes patients was independent of known cardiac disease at baseline or occurrence of non-fatal cardiac event during the follow-up.
authors.affiliation: Department of Internal Medicine, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850, Lahti, Finland. antti.eranti@helsinki.fi.
authors.forename: Antti
authors.initials: A
authors.lastname: Eranti
authors.affiliation: Department of Internal Medicine, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850, Lahti, Finland. tuomas.kerola@phsotey.fi.
authors.forename: Tuomas
authors.initials: T
authors.lastname: Kerola
authors.affiliation: Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland. aapo.aro@helsinki.fi.
authors.forename: Aapo L
authors.initials: AL
authors.lastname: Aro
authors.affiliation: Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland. jani.tikkanen@gmail.com.
authors.forename: Jani T
authors.initials: JT
authors.lastname: Tikkanen
authors.affiliation: Department of Health, Functional Capacity, and Welfare, National Institute for Health and Welfare, Helsinki, Finland. harri.rissanen@thl.fi.
authors.forename: Harri A
authors.initials: HA
authors.lastname: Rissanen
authors.affiliation: Department of Internal Medicine, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850, Lahti, Finland. olli.anttonen@phsotey.fi.
authors.forename: Olli
authors.initials: O
authors.lastname: Anttonen
authors.affiliation: Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland. juhani.junttila@oulu.fi.
authors.forename: M Juhani
authors.initials: MJ
authors.lastname: Junttila
authors.affiliation: Department of Health, Functional Capacity, and Welfare, National Institute for Health and Welfare, Helsinki, Finland. paul.knekt@thl.fi.
authors.forename: Paul
authors.initials: P
authors.lastname: Knekt
authors.affiliation: Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland. heikki.huikuri@oulu.fi.
authors.forename: Heikki V
authors.initials: HV
authors.lastname: Huikuri
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D016022:Case-Control Studies; D002423:Cause of Death; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D048909:Diabetes Complications / Q000097:blood / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D018149:Glucose Intolerance / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D005951:Glucose Tolerance Test; D006321:Heart / Q000294:innervation; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose