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Huang Q, Shi W, Wang M, Zhang L, Zhang Y, Hu Y, Pan S, Ling B, Zhu H, Xiao W, Hua T, Yang M. Canagliflozin attenuates post-resuscitation myocardial dysfunction in diabetic rats by inhibiting autophagy through the PI3K/Akt/mTOR pathway. iScience 2024; 27:110429. [PMID: 39104415 PMCID: PMC11298657 DOI: 10.1016/j.isci.2024.110429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 06/03/2024] [Accepted: 06/28/2024] [Indexed: 08/07/2024] Open
Abstract
This study investigated the effects of canagliflozin on myocardial dysfunction after cardiac arrest and cardiopulmonary resuscitation in diabetic rats and the underlying mechanisms. Male rats with type 2 diabetes mellitus (T2DM) were subjected to a modified epicardial fibrillation model. Pretreatment with canagliflozin (10 mg/kg/day) for four weeks improved ATP levels, post-resuscitation ejection fraction, acidosis, and hemodynamics. Canagliflozin also reduced myocardial edema, mitochondrial damage and, post-resuscitation autophagy levels. In vitro analyses showed that canagliflozin significantly reduced reactive oxygen species and preserved mitochondrial membrane potential. Using the PI3K/Akt pathway inhibitor Ly294002, canagliflozin was shown to attenuate hyperautophagy and cardiac injury induced by high glucose and hypoxia-reoxygenation through activation of the PI3K/Akt/mTOR pathway. This study highlights the therapeutic potential of canagliflozin in post-resuscitation myocardial dysfunction in diabetes, providing new insights for clinical treatment and experimental research.
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Affiliation(s)
- Qihui Huang
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
| | - Wei Shi
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
| | - Minjie Wang
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
| | - Liangliang Zhang
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
| | - Yijun Zhang
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
| | - Yan Hu
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
| | - Sinong Pan
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
| | - Bingrui Ling
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
| | - Huaqing Zhu
- Laboratory of Molecular, Biology and Department of Biochemistry, Anhui Medical University, Hefei 230022, Anhui, People’s Republic of China
| | - Wenyan Xiao
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
| | - Tianfeng Hua
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
| | - Min Yang
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, People’s Republic of China
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Chakraborty P, Nattel S, Nanthakumar K, Connelly KA, Husain M, Po SS, Ha ACT. Sudden cardiac death due to ventricular arrhythmia in diabetes mellitus: A bench to bedside review. Heart Rhythm 2024:S1547-5271(24)02676-6. [PMID: 38848857 DOI: 10.1016/j.hrthm.2024.05.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 05/27/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024]
Abstract
Diabetes mellitus (DM) confers an increased risk of sudden cardiac death (SCD) independent of its associated cardiovascular comorbidities. DM induces adverse structural, electrophysiologic, and autonomic cardiac remodeling that can increase one's risk of ventricular arrhythmias and SCD. Although glycemic control and prevention of microvascular and macrovascular complications are cornerstones in the management of DM, they are not adequate for the prevention of SCD. In this narrative review, we describe the contribution of DM to the pathophysiologic mechanism of SCD beyond its role in atherosclerotic cardiovascular disease and heart failure. On the basis of this pathophysiologic framework, we outline potential preventive and therapeutic strategies to mitigate the risk of SCD in this population of high-risk patients.
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Affiliation(s)
- Praloy Chakraborty
- Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Kumaraswamy Nanthakumar
- Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kim A Connelly
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Keenan Research Centre for Biomedical Science, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Mansoor Husain
- Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ontario, Canada
| | - Sunny S Po
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Andrew C T Ha
- Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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3
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Tao J, Zheng H, Ho HC, Wang X, Hossain MZ, Bai Z, Wang N, Su H, Xu Z, Cheng J. Urban-rural disparity in heatwave effects on diabetes mortality in eastern China: A case-crossover analysis in 2016-2019. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 858:160026. [PMID: 36356755 DOI: 10.1016/j.scitotenv.2022.160026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/25/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
Diabetics are sensitive to high ambient temperature due to impaired thermoregulation. However, available evidence on the impact of prolonged high temperature (i.e., heatwave) on diabetes deaths is limited and whether urban and rural areas differ in heatwave vulnerability remains unknown so far. A time-stratified case-crossover analysis was employed to estimate the association between heatwaves and diabetes deaths in 1486 districts (509 urban and 977 rural areas) of eastern China (Jiangsu Province), 2016-2019. For each decedent, residential heatwave exposure was measured by matching daily mean temperatures to the geocoded residential address. We adopted nine-tiered heatwave definitions incorporating intensity and duration. Stratified analyses by decedents' characteristics (gender, age, and education) were also conducted. During the study period, there were 18,685 deaths from diabetes (urban proportion: 36.95 %, p-value for urban-rural difference < 0.05). Heatwaves were associated with an increased risk of diabetes deaths, with greater and longer-lasting effects in rural areas than urban areas [e.g., rural odds ratio (OR): 1.19 (95 % confidence interval (CI): 1.14, 1.25) vs. urban OR: 1.09 (95 % CI: 1.05, 1.12)]. Risk of diabetes deaths increased with the intensity of heatwaves in rural areas (p-value for trend <0.01), but not in urban areas. Stratified analyses in rural areas suggested that females and less-educated people were more vulnerable to heatwave-related diabetes deaths. Our findings revealed the urban-rural disparity in the risk of diabetes deaths associated with heatwaves. Rural diabetics should be made aware of the increased death risk posed by heatwaves in the context of warming climate.
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Affiliation(s)
- Junwen Tao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Hao Zheng
- Department of Environmental Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Hung Chak Ho
- Department of Anaesthesiology, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | - Xiling Wang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Xuhui District, Shanghai 200231, China; Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai 200135, China
| | - Mohammad Zahid Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Zhongliang Bai
- Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, China
| | - Ning Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hong Su
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Zhiwei Xu
- School of Public Health, Faculty of Medicine, University of Queensland, 288 Herston Road, Herston, QLD 4006, Australia.
| | - Jian Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China.
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4
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Crea F. Novel risk factors for atrial fibrillation, conduction disturbances, sudden coronary death, and device infection. Eur Heart J 2022; 43:4853-4857. [PMID: 36515084 DOI: 10.1093/eurheartj/ehac734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Crea F. Percutaneous coronary intervention vs. coronary artery bypass graft: the saga continues. Eur Heart J 2022; 43:1273-1276. [PMID: 35362068 DOI: 10.1093/eurheartj/ehac118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Yang X, Wei X, Yu K, Wan C, Wang Y, Huang S, Sun Q, Huang J. Identification of myocardial fibrosis by ATR-FTIR spectroscopy combined with chemometrics. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2022; 264:120238. [PMID: 34384995 DOI: 10.1016/j.saa.2021.120238] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/12/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
Different degrees of myocardial fibrosis can often be observed in sudden cardiac death cases, so that the identification of myocardial fibrosis is an important step in forensics to identify cardiac death. Previous methods are restricted by complex algorithms, high cost, low sensitivity and high requirements. Attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy is an efficient and rapid method to identify tissue types, which has been used increasingly in forensics. This study aims to identify novel biophysical biomarkers of myocardial fibrosis and establish a prediction model by using ATR-FTIR analysis combined with chemometrics. A total of 129 tissue blocks taken from human hearts were cut into slices, and then ATR-FTIR spectroscopy and hematoxylin and eosin (HE) staining were performed. By using HE staining, the samples were divided into the experimental group (with myocardial fibrosis) and the control group (without myocardial fibrosis). The chemometrics classification results showed that the sensitivity and specificity of the training dataset were 0.91 and 1.0 respectively, and the sensitivity and specificity of the predictive dataset were 0.862 and 0.900. This study demonstrated that ATR-FTIR spectroscopy combined with chemometrics is a novel method for identifying myocardial fibrosis.
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Affiliation(s)
- Xiaorong Yang
- Department of Forensic Medicine, Guizhou Medical University, Guiyang, Guizhou, 550025, PR China
| | - Xin Wei
- College of Medicine & Forensics, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, PR China
| | - Kai Yu
- College of Medicine & Forensics, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, PR China
| | - Changwu Wan
- Department of Forensic Medicine, Guizhou Medical University, Guiyang, Guizhou, 550025, PR China
| | - Yuanhe Wang
- Department of Forensic Medicine, Guizhou Medical University, Guiyang, Guizhou, 550025, PR China
| | - Shimei Huang
- Department of Forensic Medicine, Guizhou Medical University, Guiyang, Guizhou, 550025, PR China
| | - Qinru Sun
- College of Medicine & Forensics, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, PR China.
| | - Jiang Huang
- Department of Forensic Medicine, Guizhou Medical University, Guiyang, Guizhou, 550025, PR China.
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7
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van Dongen L, de Goede P, Moeller S, Eroglu T, Folke F, Gislason G, Blom M, Elders P, Torp-Pedersen C, Tan H. Temporal variation in out-of-hospital cardiac arrest occurrence in individuals with or without diabetes. Resusc Plus 2021; 8:100167. [PMID: 34604822 PMCID: PMC8473536 DOI: 10.1016/j.resplu.2021.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/24/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Out-of-hospital cardiac arrest (OHCA) occurrence has been shown to exhibit a circadian rhythm, following the circadian rhythm of acute myocardial infarction (AMI) occurrence. Diabetes mellitus (DM) is associated with changes in circadian rhythm. We aimed to compare the temporal variation of OHCA occurrence over the day and week between OHCA patients with DM and those without. Methods In two population-based OHCA registries (Amsterdam Resuscitation Studies [ARREST] 2010-2016, n = 4163, and Danish Cardiac Arrest Registry [DANCAR], 2010-2014, n = 12,734), adults (≥18y) with presumed cardiac cause of OHCA and available medical history were included. Single and double cosinor analysis was performed to model circadian variation of OHCA occurrence. Stratified analysis of circadian variation was performed in patients with AMI as immediate cause of OHCA. Results DM patients (22.8% in ARREST, 24.2% in DANCAR) were older and more frequently had cardiovascular risk factors or previous cardiovascular disease. Both cohorts showed 24 h-rhythmicity, with significant amplitudes in single and double cosinor functions (P-range < 0.001). In both registries, a morning peak (10:00-11:00) and an evening peak (20:00-21:00) was observed in both DM and non-DM patients. No septadian variation was observed in either DM or non-DM patients (P-range 0.13-84). Conclusions In these two population-based OHCA registries, we observed a similar circadian rhythm of OHCA occurrence in DM and non-DM patients.
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Affiliation(s)
- L.H. van Dongen
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Experimental and Clinical Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - P. de Goede
- Laboratory of Endocrinology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Hypothalamic Integration Mechanisms Group, Netherlands Institute for Neuroscience (NIN), an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - S. Moeller
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - T.E. Eroglu
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Experimental and Clinical Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - F. Folke
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
- Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | - G. Gislason
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| | - M.T. Blom
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Experimental and Clinical Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - P.J.M. Elders
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice Medicine, Amsterdam Public Health Institute, De Boelelaan 1117, Amsterdam, Netherlands
| | - C. Torp-Pedersen
- Department of Cardiology, North Zealand Hospital, Hillerød, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Public Health, University of Copenhagen, Denmark
| | - H.L. Tan
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Experimental and Clinical Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands
- Corresponding author at: Amsterdam UMC, Academic Medical Center, Heart Center, Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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Quantitative Analysis of Different Multi-Wavelength PPG Devices and Methods for Noninvasive In-Vivo Estimation of Glycated Hemoglobin. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11156867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Diabetes is a serious disease affecting the insulin cycle in the human body. Thus, monitoring blood glucose levels and the diagnosis of diabetes in the early stages is very important. Noninvasive in vivo diabetes-diagnosis procedures are very new and require thorough studies to be error-resistant and user-friendly. In this study, we compare two noninvasive procedures (two-wavelength- and three-wavelength-based methods) to estimate glycated hemoglobin (HbA1c) levels in different scenarios and evaluate them with error level calculations. The three-wavelength method, which has more model parameters, results in a more accurate estimation of HbA1c even when the blood oxygenation (SpO2) values change. The HbA1c-estimation error range of the two-wavelength model, due to change in SpO2, is found to be from −1.306% to 0.047%. On the other hand, the HbA1c estimation error for the three-wavelength model is found to be in the magnitude of 10−14% and independent of SpO2. The approximation of SpO2 from the two-wavelength model produces a lower error for the molar concentration based technique (−4% to −1.9% at 70% to 100% of reference SpO2) as compared to the molar absorption coefficient based technique. Additionally, the two-wavelength model is less susceptible to sensor noise levels (max SD of %error, 0.142%), as compared to the three-wavelength model (max SD of %error, 0.317%). Despite having a higher susceptibility to sensor noise, the three-wavelength model can estimate HbA1c values more accurately; this is because it takes the major components of blood into account and thus becomes a more realistic model.
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Lüscher TF. Nutrition, obesity, diabetes, and cardiovascular outcomes: a deadly association. Eur Heart J 2021; 41:2603-2607. [PMID: 33216914 DOI: 10.1093/eurheartj/ehaa622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Professor of Cardiology, Imperial College and Director of Research, Education & Development, Royal Brompton and Harefield Hospital London, UK.,Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland.,Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, 8032 Zurich, Switzerland
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Abstract
PURPOSE OF REVIEW Persons with diabetes mellitus (DM) have increased morbidity and mortality rates compared with persons without DM. Sudden cardiac death (SCD) is a leading cause of death, and multiple studies have found an increased risk of SCD among individuals with DM. This review sought to collect the latest knowledge of the epidemiological and pathophysiological interplay between DM and SCD. RECENT FINDINGS Persons with DM have a two- to tenfold increased risk of SCD compared with persons without DM. The underlying mechanisms for the increased risk of SCD are complex and multifactorial. The main pathophysiological contributors are DM-induced cardiac autonomic neuropathy (CAN), metabolic changes, silent ischemia, and polypharmacy. Persons with DM have an increased risk of SCD. Future studies should focus on CAN and the combined risk of QT prolongation from the interplay between CAN, hypoglycemia, and polypharmacy. Genes and pathways involved in control of the autonomic nervous system and cardiac ion channels could be a future focal point.
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