Sudden Death Risk is Very High in 35-Year-Olds With Diabetes

LONDON — Patients with either type of diabetes, but especially type 1, have higher incidence rates of sudden cardiac death (SCD) across age groups, showed data from a nationwide study. The heightened risk underscores the importance of improved risk stratification for these patients.

“We know that patients with diabetes have several risk factors for adverse cardiovascular events and cardiovascular disease…and as such multiple organs are involved in their disease. We, as cardiologists, need to be aware of [diabetes],” said Professor Jacob Tfelt-Hansen, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark, who presented the findings at the European Society of Cardiology (ESC) Congress 2024.

Tfelt-Hansen and his colleagues previously found a sevenfold increased risk for cardiac death in people younger than 50 years in Denmark who have diabetes compared with those who do not have diabetes.

Their latest study shows results of an investigation of the burden of SCD among individuals with diabetes in the general population. It also examined the extent of life expectancy reduction attributed to SCD in people with types 1 and 2 diabetes.

Relative Risk

The researchers drew on 2010 data from the entire Danish population (approximately 5.5 million individuals). They identified 6851 cases of SCD, which were matched to individuals with types 1 and 2 diabetes based on prescription data. Finally, the researchers identified loss of life years for each diagnostic group.

Of those who experienced SCD, 155 had type 1 diabetes, 1055 had type 2 diabetes, and 5641 did not have diabetes at all.

The mean age of individuals with type 1 diabetes was 50 years, 57% were men, and arrythmia was present in 5.5% of cases. For type 2 diabetes, mean age was 65 years, 52% were men, and arrythmia was present in 11% of cases.

Incidence rates of SCD were consistently elevated across all age groups (0-90 years) for individuals with diabetes vs the general population.

“Cardiac disease was more common in the diabetes patients but so too were other diseases, compared with the general population. So chronic kidney disease, for example, is found in 0.6%, 12.0%, and 5.9% in the general, type 1, and type 2 diabetes populations, respectively,” said Tfelt-Hansen. Pulmonary and neurologic diseases were also higher in diabetes populations.

Incidence per 100,000 person-years showed that type 1 diabetes carried an increased risk for SCD relative to the general population across all ages up to 90 years, while the specific incidence rate ratios of SCD by age group showed a nearly 10-fold increased risk at ≤ 30 years, a 20-fold increased relative risk in ages 30-40 years (95% CI, 11.8-80.0), which then decreases with age up to 90 years, explained Tfelt-Hansen. 

Those with type 2 diabetes had a nearly sixfold increased relative risk in the age group up to 30 years, a 5.6-fold increased relative risk in ages 30-40 years (95% CI, 2.7-14.0), and a decrease in that relative risk up to age 90 years.

The study found that total (all-cause) life years lost at age 30 years was nearly 14 years for an individual with type 1 diabetes, and of these, 3.8 were due to SCD. “For type 2 diabetes, the life years lost are less pronounced at 6.1 total life years lost, with 2.2 years of these lost to SCD,” he said.

Prevention and Monitoring Are Key

“The way we could try to prevent [SCD], of course, could be [by] better treatment for patients who have diabetes, but we need to prevent type 2 diabetes in the first place. And, as cardiologists in particular, it is essential for us to step up and do this,” he stressed, alluding to lifestyle factors.

“However, once you have an individual with diabetes, we need to monitor the [heart-related] symptoms. We know that with other diseases, up to 50% of the young who have SCD have symptoms of syncope or angina, for example.”

Elijah R. Behr, professor of cardiovascular medicine at St George’s University Hospitals, London, England, remarked that the relative risk of 20-fold in individuals aged 30-40 years with type 1 diabetes is incredibly high. He asked if cardiologists should take type 1 diabetes into account as a risk factor for aggressive therapy, like implantable cardioverter defibrillator therapy.

Tfelt-Hansen responded that he does not think this case meets the threshold for a net benefit from using an implantable cardioverter defibrillator. However, he agreed with Behr’s following suggestion that patients with type 1 diabetes aged 30-40 years might be suitable for a wearable monitoring device.

No relevant disclosures were declared.