Diabetes, Heart and Cardiovascular Diseases News Chronicle.  Diabetes, Cardiovascular and Heart Diseases
 Article 306
    Published on February 15, 2018

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

Earlier studies show heart attack (medical name myocardial infarction MI) events causes a 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.

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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 effects of sitagliptin (DPP-4 Inhibitor) drug along with their current drug therapy on patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes. The 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 diseases (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 a three-year follow-up studies, following deaths due to various causes were observed by the researchers.

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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 table 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 show a 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. The study also found a decreased risk of all-cause mortality among individuals with an elevated estimated glomerular filtration (eGFR), females people and having a history of percutaneous coronary intervention (PCI or coronary angioplasty).

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The study found a higher risk of all-cause mortality with an increase in age, with an 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 diseases (ASCVD). But reasons for this sudden death are not known. Researchers say more investigations are required to uncover the mechanism.

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Limitations of this study are:

  • Causes of death of 20 percent of the participants are not known.
  • Nonavailability of ejection fraction data.
  • The TECOS participants study results may not reflect general atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes population.

Reduction in cardiovascular death mortality with heart failure prevention and lower blood sugar glucose.
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The corresponding author of the study was Abhinav Sharma, MD, Cardiologist, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, the 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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