Recent research at the EASD meeting reveals that certain medications, low fasting blood sugar, and cardiovascular conditions significantly increase sudden cardiac arrest risk in type 2 diabetics, underscoring the need for careful management by GPs.
Low fasting blood sugar is associated with sudden cardiac arrest (SCA), a leading cause of mortality.
Recent findings presented at the European Association for the Study of Diabetes Annual Meeting in Hamburg, Germany, highlight several factors linked to an increased risk of sudden cardiac arrest in people with type 2 diabetes.
Key risk factors identified include certain widely used antibiotics and antipsychotic medications, prokinetics (medications for gastrointestinal issues like nausea and vomiting), and low levels of fasting blood sugar.
Sudden Cardiac Arrest: A Major Health Concern
Sudden cardiac arrest (SCA) is a leading cause of death. The 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.
People with type 2 diabetes (T2D) have a two-fold increased risk of SCA. However, SCA is still difficult to predict, particularly in those without a history of cardiovascular disease (CVD).
Peter Harms, of Amsterdam UMC, Amsterdam, The Netherlands, and colleagues carried out a case-control study to assess which clinical characteristics in GP records are associated with SCA in people with T2D with and without a CVD history.
The study involved 3,919 individuals with T2D: 689 cases and 3,230 controls. The cases, individuals who had a sudden cardiac arrest in the Dutch region of Noord-Holland from 2010-2019, were each matched by age, sex, and GP practice with up to five non-SCA controls.
Clinical measurements including blood pressure and blood glucose readings, medication use, and medical history for five 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 an increased risk of SCA in both people with and without CVD: history of arrhythmias (68% increase in the risk of SCA), unknown smoking behavior (40% increase), insulin use (138% increase) and QTc-prolonging prokinetic medication (66% increase)
Many common drugs, including some prokinetic, antibiotic, and antipsychotic medications, are associated with a change in the functioning of the heart’s electrical system known as QT-prolongation and are described as being QTc-prolonging. QTc-prolonging prokinetics include domperidone; QTc-prolonging antibiotics include macrolides and fluoroquinolones; QTc-prolonging antipsychotics include haloperidol.
Specific Risks Based on CVD History
In people with CVD (352 cases/1,207 controls), moderate (54% increase in risk), severe (55% increase) and unknown albuminuria (90% increase), and heart failure (85% increase) were associated with SCA.
In those without CVD (337 cases/2,023 controls), low fasting glucose – an indication of too strict glycaemic control (<4.5 mmol/mol: 150% increase), severely high systolic blood pressure (>180mmHg: 121% increase), low HDL cholesterol (<1.0 mmol/l: 35% increase), high LDL cholesterol (>2.6 mmol/l: 64% increase), QTc-prolonging anti-psychotic medication (187% increase) and QTc-prolonging antibiotic medication (66% increase) use were associated with SCA.
The researchers conclude: “In people with T2D with CVD, albuminuria, heart failure and QTc-prolonging prokinetic medication use are associated with risk of SCA, while in people with T2D without a CVD history, low fasting glucose, severe hypertension, dyslipidemia (unhealthy levels of blood fats) and the use of QTc-prolonging antibiotic, antipsychotic and prokinetic medication are associated with SCA risk.”
Mr Harms adds: “GPs will already be aware that classic cardiovascular risk factors such as high blood pressure raise the risk of sudden cardiac arrest in people with type 2 diabetes, however, the link with low fasting glucose and antibiotic, antipsychotic and prokinetic medication is less well-known.
“Our results underline the need for GPs to be aware of the hazards of too strict glycaemic control and the prescription of commonly used antibiotics, antipsychotics, and prokinetics.”
Reference: “Association of clinical characteristics with sudden cardiac arrest in people with type 2 diabetes with and without CVD: a longitudinal case-control study on primary care data” by P.P. Harms, L.H. van Dongen, F.C. Bennis, K.M.A. Swart, M. Hoogendoorn, J.W.J. Beulens, H.L. Tan, P. Elders and M.T. Blom, Annual Meeting of the European Association for the Study of Diabetes (EASD).
Abstract
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