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Impaired FPG, type 2 diabetes represent risk factors for sudden cardiac death, all-cause mortality, study reveals

Wednesday, May 22 2013 | Comments
Evidence Grade 0 What's This?
Men who have impaired fasting plasma glucose (FPG), regardless of whether or not they have type 2 diabetes, appear to have an increased risk of out-of-hospital sudden cardiac death (SCD), according to recent data.

A team of researchers investigated risk predictors for atherosclerotic cardiovascular outcomes in a population-based sample of men from eastern Finland. The prospective study involved 2,641 men aged 42 to 60 years who were followed up for an average of 18.8 years.

Impaired FPG was defined according to the American Diabetes Association recommendations (>=5.6 mmol/L). In all, 159 (6.4%) study participants had type 2 diabetes at baseline, of whom only 6 were treated with insulin therapy, while 501 (20.1%) study participants had impaired FPG but not diabetes.

During follow-up, 190 SCDs occurred. Of those, 82.6% (n=157) occurred in out-of-hospital conditions. In addition, 71.9% (n=136) of all the documented SCDs were the result of documented ventricular tachycardia, ventricular fibrillation, or death, with the autopsy revealing no other reason.

A total of 587 nonfatal coronary heart disease (CHD) events were reported. Among the men with normal FPG levels (<5.6 mmol/L), 146 SCDs occurred (2.8 cases per 1,000 person-years). Among the men with impaired FPG and no diabetes, there were 50 SCDs (5.6 cases per 1,000 person-years), while among those with diabetes, there were 29 SCDs (11.6 cases per 1,000 person-years).

After adjusting for other risk factors, a 1 mmol/L increment in FPG was related to an increase of 10% in the risk of SCD (relative risk [RR], 1.10; 95% CI, 1.04–1.20; P=.001)

Among the 2,482 men without type 2 diabetes at baseline, the relative risk for SCD was 1.32 (95% CI, 1.04-1.82; P<.001).

The overall risk of SCD among the men with impaired FPG and no diabetes was 51% (RR, 1.51; 95% CI, 1.07–2.14; P=.02) higher and 2.86-fold (RR. 2.86; 95% CI, 1.87–4.38; P<0.001) for the men with type 2 diabetes as compared with the men with normal FPG levels, after adjustment for age, body mass index, systolic blood pressure, serum LDL cholesterol, smoking, alcohol consumption, prevalent CHD, and family history of CHD.

The risk of out-of-hospital SCD was 79% (RR, 1.79; 95% CI, 1.24–2.58; P=.001) higher for the men with impaired FPG and no diabetes and 2.26-fold (RR, 2.26; 95% CI, 1.34–3.77; P<.001) higher for the men with type 2 diabetes.

Impaired FPG (RR, 1.31; 95% CI, 1.11-2.87; P=.001) and type 2 diabetes (RR, 2.30; 95% CI, 1.85-2.86; P<.001) were also associated with the risk of all-cause death.

The association between impaired FPG, type 2 diabetes, and SCD remained significant even after insulin resistance was accounted for.

"Impaired FPG levels can provide valuable information as prevention appears to be a viable approach for substantially decreasing the devastating effects of sudden cardiac arrest in the general population," the study authors wrote. (Laukkanen J, et al. Diabetes Care 2013;36:1166-71.)

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