incidence of sudden cardiac death is greater in patients with diabetes. The
root cause is yet to be known.
cardiac death (SCD) is a sudden, natural and unexpected death that arises due
to a loss of functioning of the heart. It can occur in a person with no
symptoms at all, as well as in those with advanced heart disease. SCD occurs
when a structural abnormality of the heart is coupled with a disturbance in the
electrical system of the heart. This leads to fatal arrhythmias. However, no
definable structural cardiac abnormality may be found at all in some cases (in
5% to 10% of SCD cases, according to studies).
It is unfortunate that no single test is available to
identify individuals at increased risk of SCD. This is because the exact cause
of SCD is multifactorial, i.e. depends on a number of factors. Uncontrolled
diabetes and its complications is just one such factor.
has been associated with sudden cardiac death, although the exact direct
relationship is unclear.
is a known risk factor for common
preventable conditions associated with SCD. These include diseases of the blood
supply of the heart (coronary artery disease (CAD), heart attack) and those
leading to heart failure. It is possible that diabetes affects the heart due to
its action on big as well as smaller blood vessels. Diabetes affects autonomic
nerves that supply to the heart, which in turn could affect the rate and rhythm
of the heart, resulting in sudden cardiac death.
diabetes under control is of great importance. This can be achieved with
healthy life style modifications with or without supplementary medications. A
number of oral drugs and easy-to-use insulin preparations are available. It is
also vital to note that several studies found detrimental effects of over
correction of diabetes. Intensive blood glucose correction may reduce the risk
of diabetes complications, but it also increases the incidence of hypoglycemia
(dangerously low blood sugar).
such as smoking, high cholesterol levels and obesity may tamper with the
healthy blood circulation in individuals building up clots (thrombus) and
plaques that are dangerous. Elderly women are at greater risk of plaque
rupture. Cigarette smokers are twice to thrice at risk of developing plaques
when compared to non-smokers. Tobacco cessation is thus protective to the
factors are also known to add to the risk factor for SCD. A history of SCD in
the family, especially in parents, places an individual at a high risk of the
adverse event. Tests to identify the susceptible are yet to be available.
with coronary artery disease (CAD) are at high risk of SCD and hence should be
dealt with caution. Most efforts to stratify SCD risks have focused on these
patients. There are no standardized recommendations for predicting risk in
patients who have no underlying structural heart disease. Though diabetes is
recognized as a clinical risk marker, it is not used for risk stratification to
sudden and unpredictable nature of SCD and our current state of helplessness
with respect to better diagnosis leaves us clinging to the age old dictum
'prevention is better than cure'. Slowing the progression or development of
heart diseases, achieving a healthy control of diabetes and timely management
of hypertension and high cholesterol levels are known to lessen the risk of
SCD. Sudden Cardiac Death prevention
strategies for the general population are the same as those for patients with
events like sudden cardiac arrests can be treated and reversed with immediate
emergency actions. Devices such as automated external defibrillators and
implantable cardioverter defibrillators (ICDs) remain a mainstay of SCD
and Sudden Cardiac Death; Jennifer D. Smith et al; US Pharmacist 2013