Decreased fasting blood glucose levels are associated with sudden cardiac arrest (SCA) and are a leading cause of death.
Recent findings presented at the European Society of Diabetes Annual Meeting in Hamburg, Germany highlight several factors associated with an increased risk of sudden cardiac arrest in patients with type 2 diabetes.
Key risk factors identified include certain widely used antibiotics and antipsychotics, prokinetic drugs (medications for gastrointestinal problems such as nausea and vomiting), and low fasting blood sugar levels .
Sudden cardiac arrest: a serious health concern
Sudden cardiac arrest (SCA) is the leading cause of death. This condition, in which the heart suddenly stops pumping blood, is responsible for up to 50% of cardiac deaths and 20% of mortality in high-income countries.
Patients with type 2 diabetes (T2D) have a two-fold increased risk of SCA. However, predicting SCA remains difficult, especially in patients without a history of SCA. cardiovascular disease (CVD).
Peter Harms and colleagues at Amsterdam UMC in Amsterdam, Netherlands, conducted a case-control study to assess which clinical features in GP records are associated with SCA in patients with and without a history of CVD.
This study included 3,919 patients with T2D (689 cases and 3,230 controls). The cases were individuals who suffered a sudden cardiac arrest in the North Holland region of the Netherlands between 2010 and 2019, and were each matched on age, gender, general practitioner status, and up to five non-SCA controls.
clinical measurements such as blood pressure and blood sugar measurements; Drug use and medical history over the 5 years leading up to the case’s SCA were obtained from GP records. Measurements not recorded in the records were classified as “unknown.”
Risk factors for SCA
Several characteristics were associated with increased risk of SCA, with or without CVD: history of arrhythmia (68% increased risk of SCA), unknown smoking behavior (40% increased), insulin use (138% increase) and QTc prolongation drug use (66% increase)
Many common drugs, including some prokinetic drugs, antibiotics, and antipsychotics, have been associated with changes in the functioning of the heart’s electrical system, known as QT prolongation, and have been described as having QTc prolonging effects. I am. QTc prolongation prokinetic agents include domperidone. QTc prolonging antibiotics include macrolides and fluoroquinolones. QTc prolonging antipsychotics include haloperidol.
Specific risks based on CVD history
In CVD patients (352 cases/1,207 controls), moderate (54% increased risk), severe (55% increased risk), unknown albuminuria (90% increased), and heart failure (85% increased) were associated with SCA. was.
Patients without CVD (337 cases/2,023 controls), decreased fasting blood glucose levels – a sign of too tight glycemic control (<4.5 mmol/mol: 150%増加)、極度に高い収縮期血圧(>180mmHg: 121% increase), low blood pressure HDL cholesterol (<1.0 mmol/l: 35% 増加)、高 LDL コレステロール (>The use of QTc-prolonging antipsychotics (187% increase) and QTc-prolonging antibiotic medication (66% increase) were associated with SCA.
The researchers concluded that, “In T2D patients with CVD, albuminuria, heart failure, and use of QTc prolonging drugs are associated with the risk of SCA, whereas in T2D patients without a history of CVD, low fasting blood glucose levels, “Severe hypertension and dyslipidemia (unhealthy) result,” the authors conclude. blood fat levels) and the use of QTc-prolonging antibiotics, antipsychotics, and prokinetic drugs are associated with SCA risk. ”
Harms added: “GPs will already be aware that classic cardiovascular risk factors such as high blood pressure increase the risk of sudden cardiac arrest in patients with type 2 diabetes, but The relationship between the decline and antibiotics, antipsychotics, and prokinetic drugs is less well known.
“Our results highlight the need for general practitioners to be aware of the risks of too tight glycemic control and prescribing commonly used antibiotics, antipsychotics and prokinetic drugs.”
Reference: “Association of clinical characteristics with sudden cardiac arrest in patients with type 2 diabetes with and without CVD: a longitudinal case-control study of primary care data” PP Harms, LH van Dongen, FC Bennis, KMA Swart, M. Hoogendoorn, JWJ Beulens, HL Tan, P. Elders, MT Blom, European Association for the Study of Diabetes (EASD) Annual Meeting.
abstract