A large study on sudden death in young adults focuses on diabetes

BarcelonaA young person, around 40 years old and seemingly healthy, unexpectedly loses consciousness and collapses. Perhaps they had experienced palpitations, dizziness, or chest pain just before collapsing, but probably didn't have time to report it. They no longer have a pulse and require cardiopulmonary resuscitation (CPR). But within a few minutes, they die. Any underlying illness is ruled out, and it is concluded that they suffered sudden cardiac death.

The cause of this unexpected death is an electrical disorder of the heart that prevents it from beating properly. It is more common in people with heart disease, a family history of heart disease, or risk factors such as high cholesterol, high blood pressure, or the use of certain medications, such as antiarrhythmics. But diabetes is also a significant factor. In fact, the risk of sudden cardiac death is higher in people with this metabolic disorder, according to a publication endorsed by the European Society of Cardiology (ESC), especially among those under 50.

A comprehensive study published this Thursday in the European Heart Journal The ESC's internationally recognized journal suggests that people with diabetes have a higher risk of unexpected death and, therefore, a shorter average life expectancy. The analysis, led by Dr. Tobias Skjelbred of Copenhagen University Hospital, includes data from the entire Danish population that died in 2010, totaling 54,028, drawn from death certificates, hospital discharge reports, and autopsies.

Researchers found a total of 6,862 sudden cardiac deaths, representing 12% of all deaths. They then consulted population records on type 1, type 2, and non-diabetic individuals and compared the rates of sudden death among the three groups. The Danish group found that, compared to the general population, sudden death was 3.7 times more common among those with type 1 diabetes—in whom the body does not produce insulin from a young age—and 6.5 times more common among those with type 2 diabetes—linked to obesity and a sedentary lifestyle, and in whom the body does not know how to use insulin properly.

Seven times higher risk in young people

In both cases, the risk difference was greater in those under 50: young adults had a seven times greater risk of sudden cardiac death. Specifically, the highest incidence rate was found in the 30-40 age group if they had type 1 diabetes, while it was higher in the 40-50 age group if they had type 2. "Although the risk increases with age for everyone, the relative difference is more pronounced when comparing young people with diabetes to the general population."

The study also showed that the average life expectancy for people with type 1 diabetes was 14.2 years shorter, while those with type 2 lived 7.9 years less. However, since this was an observational study, a link between diabetes and cardiac death can be inferred, but not causation. In this regard, the study underscores that having diabetes predisposes individuals to ischemic heart disease, and that specific factors such as hypoglycemia can increase the likelihood of suffering an arrhythmia and sudden cardiac death. However, a significant limitation of the study is that it focuses on deaths from 2010, before the widespread use of glucose-lowering therapies such as SGLT2 inhibitors and GLP-1 receptor agonists. "We cannot assess how these might have influenced sudden cardiac death in more recent years," admits Skjelbred. Indeed, experts not involved in the study describe it as "solid" and "relevant," arguing that it highlights the need to improve cardiovascular prevention measures in diabetic patients, but they also point out the gaps in the data considering the therapeutic innovations of the last 25 years. Implants and smartwatches

In an editorial accompanying the study, Dr. Hanno Tan of Amsterdam University Medical Center (AUMC) welcomes the increased research into sudden cardiac death, which is "a challenge for prevention and treatment" due to its unpredictable nature and high mortality rate. All information can be useful for improving and increasing the monitoring of people with chronic diabetes. "These findings reinforce the importance of people with diabetes working with their healthcare professionals to reduce cardiovascular risk," the cardiologist states. For example, patients known to be at very high risk of sudden death—such as those with a family history—could receive an implantable cardioverter defibrillator, and identifying subgroups within the diabetic population who could benefit from preventive measures would help reduce their risk. Another example: systems are already being developed that can automatically detect cardiac arrest and call emergency services using devices such as smartwatches.