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European Heart Journal Advance Access published online on June 24, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi376
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received August 25, 2004
Revised April 20, 2005
Accepted May 19, 2005

Clinical research

Diabetes, glucose level, and risk of sudden cardiac death

Xavier Jouven 1*, Rozenn N. Lemaître 2, Thomas D. Rea 2, Nona Sotoodehnia 2, Jean-Philippe Empana 3, and David S. Siscovick 2

1 Service de Cardiologie, Université Paris-5, Faculté René Descartes, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France; Equipe AVENIR et Unité INSERM 258, Hôpital Paul Brousse, Villejuif, France
2 University of Washington, Cardiovascular Research Unit, Metropolitan Park, East Tower, Seattle, WA 98101, USA
3 Equipe AVENIR et Unité INSERM 258, Hôpital Paul Brousse, Villejuif, France

* To whom correspondence should be addressed.
Xavier Jouven, E-mail: xavier.jouven{at}egp.ap-hop-paris.fr


  Abstract

Aims The prevalence of diabetes mellitus in industrialized countries is rapidly increasing, and diabetes is suspected to carry a particular high risk for sudden cardiac death (SCD).

Methods and results We conducted a population-based case-control study at Group Health Cooperative. Cases (n = 2040) experienced out-of-hospital cardiac arrest due to heart disease between 1980 and 1994. Controls (n = 3800) were a stratified random sample of enrollees. Diabetes status was classified into four exclusive groups: (i) no diabetes, (ii) borderline, (iii) diabetes without microvascular disease (retinopathy or proteinuria), and (iv) diabetes with microvascular disease. When compared with no diabetes, we observed progressively higher risk of SCD associated with borderline diabetes [Odds ratio (OR) = 1.24 (0.98-1.57)], diabetes without microvascular disease [OR = 1.73 (1.28-2.34)], and diabetes with microvascular disease [OR = 2.66 (1.84-3.85)], after adjustment for potential confounders (P-value for trend <0.001). Higher glucose levels were also associated with the risk of SCD both in the absence and in the presence of microvascular disease. However, subjects with microvascular complications but with glucose level <7.7 mmol/L were not at significant increased risk of SCD.

Conclusion These results emphasize the role of diabetes as a strong risk factor for SCD and outline the importance of glucose level at every stage of diabetes severity.

Keywords: Sudden death; Cardiac arrest; Diabetes; Glycaemia.
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