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Eken B, Rawshani A, Rawshani A, Mandalenakis Z, Thunstrom E, Louca A, Petursson P, Angerås O, Nadhir S, Dworeck C, Råmunddal T. Effects of pre-existing type 1 diabetes mellitus on survival outcome following out-of-hospital cardiac arrest: a registry-based observational study in Sweden. BMJ Open 2024; 14:e080710. [PMID: 39009457 PMCID: PMC11253740 DOI: 10.1136/bmjopen-2023-080710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 06/21/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND It has been estimated that 80% of cases of out-of-hospital cardiac arrest (OHCA) are due to cardiac causes. It is well-documented that diabetes is a risk factor for conditions associated with sudden cardiac arrest. Type 1 diabetes (T1D) displays a threefold to fivefold increased risk of cardiovascular disease and death compared with the general population. OBJECTIVE This study aims to assess the characteristics and survival outcomes of individuals with and without T1D who experienced an OHCA. Design: A registry-based nationwide observational study with two cohorts, patients with T1D and patients without T1D. Setting: All emergency medical services and hospitals in Sweden were included in the study. PARTICIPANTS Using the Swedish Cardiopulmonary Resuscitation Registry, we enrolled 54 568 cases of OHCA where cardiopulmonary resuscitation was attempted between 2010 and 2020. Among them, 448 patients with T1D were identified using International Classification of Diseases-code: E10. METHODS Survival analysis was performed using Kaplan-Meier and logistic regression. Multiple regression was adjusted for age, sex, cause of arrest, prevalence of T1D and time to cardiopulmonary resuscitation. MAIN OUTCOME MEASURES The outcomes were discharge status (alive vs dead), 30 days survival and neurological outcome at discharge. RESULTS There were no significant differences in patients discharged alive with T1D 37.3% versus, 46% among cases without T1D. There was also no difference in neurological outcome. Kaplan-Meier curves yielded no significant difference in long-term survival. Multiple regression showed no significant association with survival after accounting for covariates, OR 0.99 (95% CI 0.96 to 1.02), p value=0.7. Baseline characteristics indicate that patients with T1D were 5 years younger at OHCA occurrence and had proportionally fewer cases of heart disease as the cause of arrest (57.6% vs 62.7%). CONCLUSION We conclude, with the current sample size, that there is no statistically significant difference in long-term or short-term survival between patients with and without T1D following OHCA.
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Affiliation(s)
- Berkan Eken
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden
| | - Aidin Rawshani
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden
| | - Erik Thunstrom
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden
| | - Antros Louca
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden
| | - Petur Petursson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden
| | - Sadek Nadhir
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christian Dworeck
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden
| | - Truls Råmunddal
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden
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Eroglu TE, Coronel R, Zuurbier CJ, Blom M, de Boer A, Souverein PC. Use of sodium-glucose cotransporter-2 inhibitors and the risk for sudden cardiac arrest and for all-cause death in patients with type 2 diabetes mellitus. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 9:18-25. [PMID: 35894858 PMCID: PMC9780744 DOI: 10.1093/ehjcvp/pvac043] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/06/2022] [Accepted: 07/24/2022] [Indexed: 12/27/2022]
Abstract
AIMS Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) are antidiabetic agents that can have direct cardiac effects by impacting on cardiac ion transport mechanisms that control cardiac electrophysiology. We studied the association between SGLT-2i use and all-cause mortality and the risk of sudden cardiac arrest (SCA) in patients with type 2 diabetes. METHODS Using data from the UK Clinical Practice Research Datalink, a cohort study among patients initiating a new antidiabetic drug class on or after January 2013 through September 2020 was conducted. A Cox regression with time-dependent covariates was performed to estimate the hazard ratios (HRs) of SCA and all-cause mortality comparing SGLT-2is with other second- to third-line antidiabetic drugs. Stratified analyses were performed according to sex, diabetes duration (<5 or ≥5 years), and the presence of cardiovascular disease. RESULTS A total of 152 591 patients were included. Use of SGLT-2i was associated with a reduced HR of SCA when compared with other second- to third-line antidiabetic drugs after adjustment for common SCA risk factors, although this association marginally failed to reach statistical significance [HR: 0.62, 95% confidence interval (95% CI): 0.38-1.01]. The HR of all-cause mortality associated with SGLT-2i use when compared with other second- to third-line antidiabetics was 0.43 (95% CI: 0.39-0.48) and did not vary by sex, diabetes duration, or the presence of cardiovascular disease. SGLT-2i use remained associated with lower all-cause mortality in patients without concomitant insulin use (HR: 0.56, 95% CI: 0.50-0.63). CONCLUSION SGLT-2i use was associated with reduced all-cause mortality in patients with type 2 diabetes. The association between use of SGLT-2i and reduced risk of SCA was not statistically significant.
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Affiliation(s)
| | - Ruben Coronel
- Department of Experimental and Clinical Cardiology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Coert J Zuurbier
- Department of Anaesthesiology, Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Amsterdam UMC, Location Academic Medical Centre (AMC), University of Amsterdam, Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands
| | - Marieke Blom
- General Practice, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands,Health Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, 1105 BP Amsterdam, The Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CS Utrecht, The Netherlands
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3
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Portero V, Nicol T, Podliesna S, Marchal GA, Baartscheer A, Casini S, Tadros R, Treur JL, Tanck MWT, Cox IJ, Probert F, Hough TA, Falcone S, Beekman L, Müller-Nurasyid M, Kastenmüller G, Gieger C, Peters A, Kääb S, Sinner MF, Blease A, Verkerk AO, Bezzina CR, Potter PK, Remme CA. Chronically elevated branched chain amino acid levels are pro-arrhythmic. Cardiovasc Res 2022; 118:1742-1757. [PMID: 34142125 PMCID: PMC9215196 DOI: 10.1093/cvr/cvab207] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/16/2021] [Indexed: 01/03/2023] Open
Abstract
AIMS Cardiac arrhythmias comprise a major health and economic burden and are associated with significant morbidity and mortality, including cardiac failure, stroke, and sudden cardiac death (SCD). Development of efficient preventive and therapeutic strategies is hampered by incomplete knowledge of disease mechanisms and pathways. Our aim is to identify novel mechanisms underlying cardiac arrhythmia and SCD using an unbiased approach. METHODS AND RESULTS We employed a phenotype-driven N-ethyl-N-nitrosourea mutagenesis screen and identified a mouse line with a high incidence of sudden death at young age (6-9 weeks) in the absence of prior symptoms. Affected mice were found to be homozygous for the nonsense mutation Bcat2p.Q300*/p.Q300* in the Bcat2 gene encoding branched chain amino acid transaminase 2. At the age of 4-5 weeks, Bcat2p.Q300*/p.Q300* mice displayed drastic increase of plasma levels of branch chain amino acids (BCAAs-leucine, isoleucine, valine) due to the incomplete catabolism of BCAAs, in addition to inducible arrhythmias ex vivo as well as cardiac conduction and repolarization disturbances. In line with these findings, plasma BCAA levels were positively correlated to electrocardiogram indices of conduction and repolarization in the German community-based KORA F4 Study. Isolated cardiomyocytes from Bcat2p.Q300*/p.Q300* mice revealed action potential (AP) prolongation, pro-arrhythmic events (early and late afterdepolarizations, triggered APs), and dysregulated calcium homeostasis. Incubation of human pluripotent stem cell-derived cardiomyocytes with elevated concentration of BCAAs induced similar calcium dysregulation and pro-arrhythmic events which were prevented by rapamycin, demonstrating the crucial involvement of mTOR pathway activation. CONCLUSIONS Our findings identify for the first time a causative link between elevated BCAAs and arrhythmia, which has implications for arrhythmogenesis in conditions associated with BCAA metabolism dysregulation such as diabetes, metabolic syndrome, and heart failure.
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Affiliation(s)
- Vincent Portero
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, Location AMC, Room K2-104.2, Meibergdreef 9, PO Box 22700, 1100 DE Amsterdam, The Netherlands
| | - Thomas Nicol
- Mammalian Genetics Unit, MRC Harwell Institute, Harwell, Oxfordshire, UK
| | - Svitlana Podliesna
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, Location AMC, Room K2-104.2, Meibergdreef 9, PO Box 22700, 1100 DE Amsterdam, The Netherlands
| | - Gerard A Marchal
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, Location AMC, Room K2-104.2, Meibergdreef 9, PO Box 22700, 1100 DE Amsterdam, The Netherlands
| | - Antonius Baartscheer
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, Location AMC, Room K2-104.2, Meibergdreef 9, PO Box 22700, 1100 DE Amsterdam, The Netherlands
| | - Simona Casini
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, Location AMC, Room K2-104.2, Meibergdreef 9, PO Box 22700, 1100 DE Amsterdam, The Netherlands
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute and Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Jorien L Treur
- Department of Psychiatry, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Michael W T Tanck
- Amsterdam UMC, University of Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health (APH), The Netherlands
| | - I Jane Cox
- Institute of Hepatology London, Foundation for Liver Research, London, UK
- Faculty of Life Sciences & Medicine, Kings College, London, UK
| | - Fay Probert
- Department of Chemistry, University of Oxford, Oxford, UK
| | - Tertius A Hough
- Mammalian Genetics Unit, MRC Harwell Institute, Harwell, Oxfordshire, UK
| | - Sara Falcone
- Mammalian Genetics Unit, MRC Harwell Institute, Harwell, Oxfordshire, UK
| | - Leander Beekman
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, Location AMC, Room K2-104.2, Meibergdreef 9, PO Box 22700, 1100 DE Amsterdam, The Netherlands
| | - Martina Müller-Nurasyid
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- IBE, Faculty of Medicine, Ludwig Maximilian’s University (LMU) Munich, Munich, Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Gabi Kastenmüller
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Christian Gieger
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Institute of Human Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site: Munich Heart Alliance, Munich, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site: Munich Heart Alliance, Munich, Germany
| | - Stefan Kääb
- German Centre for Cardiovascular Research (DZHK), Partner Site: Munich Heart Alliance, Munich, Germany
- Department of Medicine I (Cardiology), University Hospital, LMU Munich, Munich, Germany
| | - Moritz F Sinner
- German Centre for Cardiovascular Research (DZHK), Partner Site: Munich Heart Alliance, Munich, Germany
- Department of Medicine I (Cardiology), University Hospital, LMU Munich, Munich, Germany
| | - Andrew Blease
- Mammalian Genetics Unit, MRC Harwell Institute, Harwell, Oxfordshire, UK
| | - Arie O Verkerk
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, Location AMC, Room K2-104.2, Meibergdreef 9, PO Box 22700, 1100 DE Amsterdam, The Netherlands
| | - Connie R Bezzina
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, Location AMC, Room K2-104.2, Meibergdreef 9, PO Box 22700, 1100 DE Amsterdam, The Netherlands
| | - Paul K Potter
- Department of Biological and Medical Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Carol Ann Remme
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, Location AMC, Room K2-104.2, Meibergdreef 9, PO Box 22700, 1100 DE Amsterdam, The Netherlands
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Eroglu TE, Blom MT, Souverein PC, Yasmina A, de Boer A, Tan HL. Acetylsalicylic acid use is associated with reduced risk of out-of-hospital cardiac arrest in the general population: Real-world data from a population-based study. PLoS One 2022; 17:e0267016. [PMID: 35675268 PMCID: PMC9176768 DOI: 10.1371/journal.pone.0267016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Aim
Activated blood platelet products facilitate myocardial intracellular Ca2+ overload, thereby provoking afterdepolarizations and increasing susceptibility of ischemic myocardium to ventricular fibrillation (VF). These effects are counteracted in vitro by acetylsalicylic acid (ASA), but no prior study investigated whether ASA is associated with decreased out-of-hospital cardiac arrest (OHCA) risk on a population level. Therefore, we studied whether ASA and other antiplatelet drugs (carbasalate calcium, clopidogrel) are associated with decreased risk of OHCA.
Methods
We conducted a population-based case-control study among individuals (772 OHCA-cases with documented VT/VF, 2444 non-OHCA-controls) who had used antiplatelet drugs in the year before index-date (OHCA-date), and studied the association between current antiplatelet drug use and OHCA-risk with multivariable logistic regression analysis.
Results
ASA use was associated with reduced OHCA-risk (adjusted odds ratio (ORadj) 0.6 [0.5–0.8]), and more so in women (ORadj 0.3 [0.2–0.6]) than in men (ORadj 0.7 [0.5–0.95], Pinteraction 0.021). Carbasalate calcium was associated with decreased OHCA-risk in women (ORadj 0.5 [0.3–0.9]), but not in men (ORadj 1.3 [0.96–1.7], Pinteraction 0.005). Clopidogrel was not associated with reduction in OHCA-risk. Risk reduction associated with ASA in patients with OHCA was similar in the presence of acute myocardial infarction (AMI) (ORadj 0.6 [0.4–0.9]) and in the absence of AMI (ORadj 0.7 [0.4–1.2]).
Conclusion
ASA use was associated with reduced OHCA-risk in both sexes, and more so in women, while carbasalate calcium only protected women. Clopidogrel was not associated with reduced OHCA-risk.
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Affiliation(s)
- Talip E. Eroglu
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Department of Cardiology, Copenhagen University Hospital–Herlev and Gentofte, Copenhagen, Denmark
| | - Marieke T. Blom
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Patrick C. Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Alfi Yasmina
- Department of Pharmacology, Faculty of Medicine, Lambung Mangkurat University, Banjarmasin, Indonesia
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hanno L. Tan
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
- * E-mail:
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5
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Remme CA. Sudden cardiac death in diabetes and obesity: mechanisms and therapeutic strategies. Can J Cardiol 2022; 38:418-426. [PMID: 35017043 DOI: 10.1016/j.cjca.2022.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias and sudden cardiac death (SCD) occur most frequently in the setting of coronary artery disease, cardiomyopathy and heart failure, but are also increasingly observed in individuals suffering from diabetes mellitus and obesity. The incidence of these metabolic disorders is rising in Western countries, but adequate prevention and treatment of arrhythmias and SCD in affected patients is limited due to our incomplete knowledge of the underlying disease mechanisms. Here, an overview is presented of the prevalence of electrophysiological disturbances, ventricular arrhythmias and SCD in the clinical setting of diabetes and obesity. Experimental studies are reviewed, which have identified disease pathways and associated modulatory factors, in addition to pro-arrhythmic mechanisms. Key processes are discussed, including mitochondrial dysfunction, oxidative stress, cardiac structural derangements, abnormal cardiac conduction, ion channel dysfunction, prolonged repolarization and dysregulation of intracellular sodium and calcium homeostasis. In addition, the recently identified pro-arrhythmic effects of dysregulated branched chain amino acid metabolism, a common feature in patients with metabolic disorders, are addressed. Finally, current management options are discussed, in addition to the potential development of novel preventive and therapeutic strategies based on recent insight gained from translational studies.
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Affiliation(s)
- Carol Ann Remme
- Department of Experimental Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.
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6
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Eroglu TE, Jia L, Blom MT, Verkerk AO, Devalla HD, Boink GJJ, Souverein PC, de Boer A, Tan HL. Sulfonylurea antidiabetics are associated with lower risk of out-of-hospital cardiac arrest: Real-world data from a population-based study. Br J Clin Pharmacol 2021; 87:3588-3598. [PMID: 33896015 PMCID: PMC8453495 DOI: 10.1111/bcp.14774] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/13/2021] [Accepted: 02/02/2021] [Indexed: 01/15/2023] Open
Abstract
Aims Out‐of‐hospital cardiac arrest (OHCA) mostly results from ventricular tachycardia/ventricular fibrillation (VT/VF), often triggered by acute myocardial infarction (AMI). Sulfonylurea (SU) antidiabetics can block myocardial ATP‐regulated K+ channels (KATP channels), activated during AMI, thereby modulating action potential duration (APD). We studied whether SU drugs impact on OHCA risk, and whether these effects are related to APD changes. Methods We conducted a population‐based case–control study in 219 VT/VF‐documented OHCA cases with diabetes and 697 non‐OHCA controls with diabetes. We studied the association of SU drugs (alone or in combination with metformin) with OHCA risk compared to metformin monotherapy, and of individual SU drugs compared to glimepiride, using multivariable logistic regression analysis. We studied the effects of these drugs on APD during simulated ischaemia using patch‐clamp studies in human induced pluripotent stem cell‐derived cardiomyocytes. Results Compared to metformin, use of SU drugs alone or in combination with metformin was associated with reduced OHCA risk (ORSUdrugs‐alone 0.6 [95% CI 0.4–0.9], ORSUdrugs + metformin 0.6 [95% CI 0.4–0.9]). We found no differences in OHCA risk between SU drug users who suffered OHCA inside or outside the context of AMI. Reduction of OHCA risk compared to glimepiride was found with gliclazide (ORadj 0.5 [95% CI 0.3–0.9]), but not glibenclamide (ORadj 1.3 [95% CI 0.6–2.7]); for tolbutamide, the association with reduced OHCA risk just failed to reach statistical significance (ORadj 0.6 [95% CI 0.3–1.002]). Glibenclamide attenuated simulated ischaemia‐induced APD shortening, while the other SU drugs had no effect. Conclusions SU drugs were associated with reduced OHCA risk compared to metformin monotherapy, with gliclazide having a lower risk than glimepiride. The differential effects of SU drugs are not explained by differential effects on APD.
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Affiliation(s)
- Talip E Eroglu
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Lixia Jia
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke T Blom
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Arie O Verkerk
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Medical Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Harsha D Devalla
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Medical Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gerard J J Boink
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Medical Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hanno L Tan
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
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7
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van Dongen LH, Harms PP, Hoogendoorn M, Zimmerman DS, Lodder EM, 't Hart LM, Herings R, van Weert HCPM, Nijpels G, Swart KMA, van der Heijden AA, Blom MT, Elders PJ, Tan HL. Discovery of predictors of sudden cardiac arrest in diabetes: rationale and outline of the RESCUED (REcognition of Sudden Cardiac arrest vUlnErability in Diabetes) project. Open Heart 2021; 8:openhrt-2020-001554. [PMID: 33547224 PMCID: PMC7871346 DOI: 10.1136/openhrt-2020-001554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction Early recognition of individuals with increased risk of sudden cardiac arrest (SCA) remains challenging. SCA research so far has used data from cardiologist care, but missed most SCA victims, since they were only in general practitioner (GP) care prior to SCA. Studying individuals with type 2 diabetes (T2D) in GP care may help solve this problem, as they have increased risk for SCA, and rich clinical datasets, since they regularly visit their GP for check-up measurements. This information can be further enriched with extensive genetic and metabolic information. Aim To describe the study protocol of the REcognition of Sudden Cardiac arrest vUlnErability in Diabetes (RESCUED) project, which aims at identifying clinical, genetic and metabolic factors contributing to SCA risk in individuals with T2D, and to develop a prognostic model for the risk of SCA. Methods The RESCUED project combines data from dedicated SCA and T2D cohorts, and GP data, from the same region in the Netherlands. Clinical data, genetic data (common and rare variant analysis) and metabolic data (metabolomics) will be analysed (using classical analysis techniques and machine learning methods) and combined into a prognostic model for risk of SCA. Conclusion The RESCUED project is designed to increase our ability at early recognition of elevated SCA risk through an innovative strategy of focusing on GP data and a multidimensional methodology including clinical, genetic and metabolic analyses.
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Affiliation(s)
- Laura H van Dongen
- Clinical and Experimental Cardiology, Amsterdam UMC - Locatie AMC, Heart Centre, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Peter P Harms
- General Practice Medicine, Amsterdam UMC - Locatie VUmc, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Mark Hoogendoorn
- Computer Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Dominic S Zimmerman
- Clinical and Experimental Cardiology, Amsterdam UMC - Locatie AMC, Heart Centre, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Elisabeth M Lodder
- Clinical and Experimental Cardiology, Amsterdam UMC - Locatie AMC, Heart Centre, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Leen M 't Hart
- Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands.,Biomedical Data Sciences, section Molecular Epidemiology, Leiden University Medical Centre, Leiden, Netherlands.,Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Ron Herings
- PHARMO Institute, Utrecht, Utrecht, Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam Public Health, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | - Giel Nijpels
- General Practice Medicine, Amsterdam UMC - Locatie VUmc, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Karin M A Swart
- General Practice Medicine, Amsterdam UMC - Locatie VUmc, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,PHARMO Institute, Utrecht, Utrecht, Netherlands
| | - Amber A van der Heijden
- General Practice Medicine, Amsterdam UMC - Locatie VUmc, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Marieke T Blom
- Clinical and Experimental Cardiology, Amsterdam UMC - Locatie AMC, Heart Centre, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Petra J Elders
- General Practice Medicine, Amsterdam UMC - Locatie VUmc, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Hanno L Tan
- Clinical and Experimental Cardiology, Amsterdam UMC - Locatie AMC, Heart Centre, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands .,Netherlands Heart Institute, Utrecht, Netherlands
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8
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Chuan L, Huang X, Fan C, Wen S, Yang X, Wang J, Ren J, Ru J, Ding L. Metformin ameliorates brain damage caused by cardiopulmonary resuscitation via targeting endoplasmic reticulum stress-related proteins GRP78 and XBP1. Eur J Pharmacol 2021; 891:173716. [PMID: 33197442 DOI: 10.1016/j.ejphar.2020.173716] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 12/13/2022]
Abstract
Cerebral damage after cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) is a primary cause of death. Endoplasmic reticulum stress (ERS) is very important during these situations. This study aimed to explore the role of metformin in protecting brain endoplasmic reticulum post CA/CPR. Male SD rats (n = 132) were treated with 6-min CA-posted asphyxia and sham surgery. Before CA/CPR, metformin (200 mg/kg/day) or a vehicle (0.9% saline) were administered randomly for two weeks. The neurological deficit scores were assessed 24 h, 48 h, 72 h, and 7 days after CA/CPR, and the rat brains were analyzed by Western blotting and qRT-PCR. Apoptosis was detected by the TUNEL assay according to the mitochondrial membrane potential (MMP). Oxidative stress and ERS-related protein expression were also investigated. The Western blotting and qRT-PCR results revealed that the resuscitated animals had time-dependent elevated GRP78 and XBP1 levels compared with the sham operative rats. Moreover, our results showed that the rats treated with metformin had increased neurological deficit scores (NDS), an improved seven-day survival rate, decreased cell apoptosis within the hippocampus CA1 area, and less oxidative stress compared with the CA/CPR group. Furthermore, metformin inhibited the mRNA and protein expressions of glucose-regulated protein 78 (GRP78) and X-box binding protein 1 (XBP1) in the CA/CPR rat model. We confirmed that CA/CPR can induce ERS-related apoptosis and oxidative stress in the brain; moreover, inhibiting ERS-related proteins GRP78 and XBP1 with metformin might attenuate cerebral injury post CA/CPR.
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Affiliation(s)
- Libo Chuan
- Faculty of Life Science and Biotechnology, Kunming University of Science and Technology, Kunming, 650500, China; ICU, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650500, China.
| | - Xin Huang
- ICU, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650500, China.
| | - Chuming Fan
- ICU, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650500, China.
| | - Shiyuan Wen
- ICU, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650500, China.
| | - Xiaohua Yang
- ICU, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650500, China.
| | - Jingrong Wang
- ICU, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650500, China.
| | - Jingyu Ren
- ICU, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650500, China.
| | - Jin Ru
- ICU, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650500, China.
| | - Li Ding
- Faculty of Life Science and Biotechnology, Kunming University of Science and Technology, Kunming, 650500, China; Department of Neurology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650500, China.
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9
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Mohr GH, Søndergaard KB, Pallisgaard JL, Møller SG, Wissenberg M, Karlsson L, Hansen SM, Kragholm K, Køber L, Lippert F, Folke F, Vilsbøll T, Torp-Pedersen C, Gislason G, Rajan S. Survival of patients with and without diabetes following out-of-hospital cardiac arrest: A nationwide Danish study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2019; 9:599-607. [PMID: 30632777 DOI: 10.1177/2048872618823349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research regarding out-of-hospital cardiac arrest (OHCA) survival of diabetes patients is sparse and it remains unknown whether initiatives to increase OHCA survival benefit diabetes and non-diabetes patients equally. We therefore examined overall and temporal survival in diabetes and non-diabetes patients following OHCA. METHODS Adult presumed cardiac-caused OHCAs were identified from the Danish Cardiac Arrest Registry (2001-2014). Associations between diabetes and return of spontaneous circulation upon hospital arrival and 30-day survival were estimated with logistic regression adjusted for patient- and OHCA-related characteristics. RESULTS In total, 28,955 OHCAs were included of which 4276 (14.8%) had diabetes. Compared with non-diabetes patients, diabetes patients had more comorbidities, same prevalence of bystander-witnessed arrests (51.7% vs. 52.7%) and bystander cardiopulmonary resuscitation (43.2% vs. 42.0%), more arrests in residential locations (77.3% vs. 73.0%) and were less likely to have shockable heart rhythm (23.5% vs. 27.9%). Temporal increases in return of spontaneous circulation and 30-day survival were seen for both groups (return of spontaneous circulation: 8.8% in 2001 to 22.3% in 2014 (diabetes patients) vs. 7.8% in 2001 to 25.7% in 2014 (non-diabetes patients); and 30-day survival: 2.8% in 2001 to 9.7% in 2014 vs. 3.5% to 14.8% in 2014, respectively). In adjusted models, diabetes was associated with decreased odds of return of spontaneous circulation (odds ratio 0.74 (95% confidence interval 0.66-0.82)) and 30-day survival (odds ratio 0.56 (95% confidence interval 0.48-0.65)) (interaction with calendar year p=0.434 and p=0.243, respectively). CONCLUSION No significant difference in temporal survival was found between the two groups. However, diabetes was associated with lower odds of return of spontaneous circulation and 30-day survival.
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Affiliation(s)
- Grímur Høgnason Mohr
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Kathrine B Søndergaard
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Jannik L Pallisgaard
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Sidsel Gamborg Møller
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Mads Wissenberg
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.,Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | - Lena Karlsson
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.,Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | - Steen Møller Hansen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark
| | - Kristian Kragholm
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark.,Department of Cardiology, Hjørring Regional Hospital, Denmark.,Department of Cardiology, Aalborg University Hospital, Denmark
| | - Lars Køber
- The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Freddy Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.,Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | - Tina Vilsbøll
- Clinical Metabolic Physiology, Steno Diabetes Centre Copenhagen, University of Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark.,Department of Cardiology, Aalborg University Hospital, Denmark.,Department of Health Science and Technology, Aalborg University, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
| | - Shahzleen Rajan
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
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Voruganti DC, Chennamadhavuni A, Garje R, Shantha GPS, Schweizer ML, Girotra S, Giudici M. Association between diabetes mellitus and poor patient outcomes after out-of-hospital cardiac arrest: A systematic review and meta-analysis. Sci Rep 2018; 8:17921. [PMID: 30560897 PMCID: PMC6298970 DOI: 10.1038/s41598-018-36288-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/09/2018] [Indexed: 12/23/2022] Open
Abstract
Diabetes mellitus (DM) serves as an important prognostic indicator in patients with cardiac-related illness. Our objective is to compare survival and neurological outcomes among diabetic and non-diabetic patients who were admitted to the hospital after an out-of-hospital cardiac arrest (OHCA). We searched MEDLINE and EMBASE for relevant articles from database inception to July 2018 without any language restriction. Studies were included if they evaluated patients who presented with OHCA, included mortality and neurological outcome data separately for DM patients and Non-DM patients and reported crude data, odds ratio (OR), relative risk (RR) or hazard ratio (HR). Two investigators independently reviewed the retrieved citations and assessed eligibility. The quality of included studies was evaluated using Newcastle-Ottawa quality assessment scale for cohort studies. Random-effect models using the generic variance method were used to create pooled odds ratios (OR) and 95% confidence intervals (CI). Heterogeneity was assessed using the I2 value. Survival and neurological outcomes (using modified rankin scale and cerebral performance category scale) after OHCA in hospitalized patients with DM compared with patients without DM. Out of 57 studies identified, six cohort studies met the inclusion criteria. In an analysis of unadjusted data, patients with DM had lower odds of survival, pooled OR 0.64; 95% CI, 0.52-0.78, [I2 = 90%]. When adjusted ORs were pooled, the association between DM and survival after OHCA was still significantly reduced, pooled OR 0.78, 95% CI, 0.68-0.89 [I2 = 55%]. Unadjusted pooled OR revealed poor neurological outcomes in patients with DM, pooled OR 0.55, 95% CI, 0.38-0.80 [I2 = 90%]. The result demonstrates significant poor outcomes of in-hospital survival and neurological outcomes among DM patients after OHCA.
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Affiliation(s)
- Dinesh Chandra Voruganti
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
| | - Adithya Chennamadhavuni
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Rohan Garje
- Division of Hematology and Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | | | - Saket Girotra
- Division of Cardiology, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Michael Giudici
- Division of Cardiology, University of Iowa Hospitals and Clinics, Iowa City, USA
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11
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Comparison of Survival After In-Hospital Cardiac Arrest in Patients With Versus Without Diabetes Mellitus. Am J Cardiol 2018; 121:671-677. [PMID: 29370924 DOI: 10.1016/j.amjcard.2017.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/30/2017] [Accepted: 12/07/2017] [Indexed: 12/29/2022]
Abstract
Diabetes mellitus (DM) increases the risk of sudden cardiac death, but the extent to which it influences survival after an in-hospital cardiac arrest (IHCA) remains unclear. We assessed the association of DM and survival after IHCA. The study included 1,009,073 patients aged ≥18 years who underwent cardiopulmonary resuscitation for IHCA between January 2003 and December 2013, recorded in the Nationwide Inpatient Sample database. The outcomes were survival to hospital discharge and discharge disposition assessed using multivariable logistic regression accounting for relevant covariates and clustering. Of the patients with IHCA, 30.8% (310,825) had DM and were more likely to be older and to have a higher prevalence of co-morbidities including hypertension, dyslipidemia, chronic kidney disease, and previous cardiovascular disease (all p <0.001). The rates of survival to hospital discharge after IHCA were 27.0% and 25.1% in patients with and without DM, respectively. After multivariable adjustment, DM was associated with a modestly lower risk-adjusted survival to hospital discharge (adjusted OR [aOR] 0.96, 95% confidence interval [95% CI] 0.95 to 0.97, p <0.001). This association was influenced by a number of factors (all interaction p <0.001), including a lower risk of survival among patients with DM who were younger (aOR 0.93, 95% CI 0.92 to 0.94 among those aged <75 years), those with a primary cardiovascular diagnosis (aOR 0.88, 95% CI 0.86 to 0.89), and those with ventricular fibrillation/ventricular tachycardia as the cardiac arrest rhythm (aOR 0.88, 95% CI 0.79 to 0.82). Patients with DM had lower odds of being discharged home with self-care after surviving an IHCA (p <0.001). In conclusion, preexisting DM was associated with a modestly lower risk-adjusted chance of survival after an IHCA.
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12
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Abstract
Sudden cardiac death (SCD) represents one of the most frequent causes of death in patients with diabetes. In contrast to patients without diabetes it has not been significantly reduced despite improvements in the treatment of acute myocardial infarction and long-term treatment of cardiovascular diseases as well as diabetes mellitus. Several mechanisms can be responsible for the high incidence of SCD in diabetics: 1. arrhythmogenic effects mediated via cardiac autonomic neuropathy, repolarization disturbances or sympathetic tone activation (hypoglycemia), 2. myocardial ischemia due to atherosclerosis, endothelial dysfunction, platelet aggregation or thrombophilic effects, 3. myocardial disease due to inflammation, fibrosis, associated hypertension or uremia and 4. potassium imbalance due to diabetic nephropathy or hypoglycemia. This review introduces concepts of mechanisms that are responsible for SCD in patients with diabetes. Treatment of patients with diabetes should primarily consider a systematic assessment of any deterioration of this chronic disease and of complications at an early stage. Cardiovascular drug treatment corresponds to that of non-diabetics. In antidiabetic treatment drugs with a low risk of hypoglycemia should be preferred. Treatment with implantable cardioverter defibrillators (ICD) also combined with cardiac resynchronization therapy () demonstrated a high life-saving potential particularly in patients with diabetes.
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Affiliation(s)
- C W Israel
- Klinik für Innere Medizin - Kardiologie, Diabetologie & Nephrologie, Evangelisches Krankenhaus Bielefeld, Burgsteig 13, 33617, Bielefeld, Deutschland.
| | - Y H Lee-Barkey
- Klinik für Diabetologie, Endokrinologie und Gastroenterologie, Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
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13
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Interaction of the diabetes mellitus and cardiac diseases on survival outcomes in out-of-hospital cardiac arrest. Am J Emerg Med 2016; 34:702-7. [DOI: 10.1016/j.ajem.2015.12.076] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 12/25/2015] [Accepted: 12/25/2015] [Indexed: 11/30/2022] Open
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