To the Editor— Diabetes and sudden death: Let’s assess the absolute risk increase rather than the proportional risk from sudden cardiac death!
| Autor: | João Pedro Ferreira, Faiez Zannad, Giuseppe Ambrosio, Stefano Coiro, Nicolas Girerd |
|---|---|
| Přispěvatelé: | Department of Medicine [Perugia, Italy], Università degli Studi di Perugia (UNIPG), Centre d'investigation clinique [Nancy] (CIC), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], Faculty of Medicine University of Porto, Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL) |
| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Lower risk MESH: Risk Assessment Sudden death Risk Assessment MESH: Defibrillators Implantable Sudden cardiac death Death Sudden Cardiac Female Heart Failure Humans Defibrillators Implantable Medicine (all) Cardiology and Cardiovascular Medicine Physiology (medical) [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system Internal medicine Diabetes mellitus medicine Risk factor MESH: Humans business.industry Absolute risk reduction MESH: Death Sudden Cardiac Odds ratio medicine.disease Sudden MESH: Male 3. Good health Death Heart failure MESH: Heart Failure Cardiology Implantable business Cardiac MESH: Female Defibrillators |
| Zdroj: | Heart Rhythm Heart Rhythm, Elsevier, 2015, 12 (11), pp.e138. ⟨10.1016/j.hrthm.2015.08.008⟩ |
| ISSN: | 1556-3871 1547-5271 |
| DOI: | 10.1016/j.hrthm.2015.08.008⟩ |
| Popis: | Shadman et al reported important results evaluating variables associated with the proportion of long-term risk attributable to sudden death (SD) vs non-sudden death (NSD) in patients with heart failure. The authors evaluated those associations using the proportion of SD among allcause mortality as an end point. In that analysis, diabetes was associated with a lower risk for SD (univariate: odds ratio 0.73; P o .0001). Thus, diabetes, as already highlighted, may have a greater impact on NSD than on SD. However, concluding from this analysis that implantable cardioverterdefibrillators (ICDs) are less useful in diabetic patients is probably an oversimplification. Indeed, a simple reanalysis based on absolute risk estimation could lead to a different conclusion. From their data we calculated the absolute risk difference (ARD) according to diabetic status for both SD and NSD. There were 342 of 2591 SDs (13.2%) in diabetic patients and 883 of 7294 SDs (12.1%) in nondiabetic patients, resulting in an ARD of 1.1%. There were 460 of 2591 NSDs (17.8%) in diabetic patients and 867 of 7294 NSDs (11.9%) in nondiabetic patients, resulting in an ARD of 5.9%. Thus, although diabetes is associated with an absolute risk increase of greater magnitude for NSD than for SD, diabetic patients are indeed at risk for SD, comparable to nondiabetic patients. As we emphasized previously with regard to another important condition, an increase in the absolute risk of event should eventually be the main take-home message. In this respect, ICDs should not be less recommended in diabetic patients than in nondiabetic patients; indeed, no currently available interaction analysis of randomized data investigates the impact of diabetes on ICD treatment effect. Furthermore, results from a large cohort of post–myocardial infarction patients suggest that the association between diabetes and risk for SD and for NSD is of similar magnitude. Thus, we would suggest perceiving diabetes as a risk factor for SD in patients with heart failure. |
| Databáze: | OpenAIRE |
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