Diabetes, Heart and Cardiovascular Diseases News Chronicle Diabetes, Cardiovascular and Heart Diseases. Article 306
Published on February 15, 2018 at 7:30 AM GMT

Common causes of death in patients with both type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD)

Reduction in cardiovascular death mortality with heart failure prevention and lower blood sugar glucose.

Earlier studies shows heart attack (medical name myocardial infarction MI) events causes maximum number of deaths and type 2 diabetes (T2D) may be linked with other causes of death such as cancer, heart failure, sudden death and non-cardiovascular related deaths.

A three-year double-blind and placebo-controlled study called as TECOS (Trial Evaluating Cardiovascular Outcomes with Sitagliptin) was conducted to find out causes, risk factors and prevention of mortality or death in patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes.

Researchers have evaluated affects of sitagliptin (DPP-4 Inhibitor) drug along with their current drug therapy on patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes. Total number of participants in the study were 14,735 with more than 50 years of age. All of them were diagnosed with both type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD). They were selected randomly into the study groups of either placebo or sitagliptin. Researchers used Cox proportional hazard models to determine risks linked to the causes of death.

During the three year follow-up studies, following deaths due to various causes were observed by the researchers.

Cause of death Number of deaths (%)
Cardiovascular diseases 530 (49%)
Non-cardiovascular diseases 338 (31%)
Unknown reasons 216 (20%)
Total deaths 1084

Malignancy accounted 145 (46 percent) deaths in non-cardiovascular diseases deaths. Following tables shows causes and number of deaths due to various cardiovascular related diseases.

Cause of death Number of deaths (%)
Sudden deaths 145 (27%)
Myocardial infarction (MI) or stroke 113 (21%)
Heart failure 63 (12%)

The study results shows decrease in cardiovascular related deaths such as sudden death, stroke and heart failure among patients without heart failure history. Cardiovascular mortality can be reduced with measures such as heart failure prevention, reducing blood sugar or glucose levels (HbA1c) and eGFR preservation. Study also found decreased risk of all-cause mortality among individuals with an elevated estimated glomerular filtration (eGFR), females people and having history of percutaneous coronary intervention (PCI or coronary angioplasty).

Study found higher risk to all-cause mortality with increase in age, with increase in blood sugar or glucose (HbA1c) levels and with a history of heart attack (myocardial infarction MI). This study shows "sudden death" is the most frequent cause of death in cardiovascular deaths among patients with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD). But reasons for this sudden deaths are not known. Researchers says more investigations are required to uncover the mechanism.

Limitations of this study are:

Corresponding author of the study was Abhinav Sharma, MD, Cardiologist, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, United States. The study findings were published October 6, 2017 in the Diabetes Care. Title of the article was "Causes of Death in a Contemporary Cohort of Patients With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease: Insights From the TECOS Trial." DOI : doi.org/10.2337/dc17-1091

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