Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, USA.
Cardiol J. 2010;17(2):117-29.
Diabetes mellitus has long been linked to an increased risk of sudden cardiac death. However, the magnitude of this association, and the mechanism accounting for this phenomenon, have not been precisely defined. In this review, we evaluate the epidemiological data pertaining to the association between diabetes mellitus and sudden cardiac death and discuss various proposed mechanisms that may account for this relationship. Potential factors contributing to the increased risk of sudden cardiac death observed in patients with diabetes mellitus include silent myocardial ischemia, autonomic nervous system dysfunction, abnormal cardiac repolarization, hypoglycemia, a hypercoaguable state secondary to diabetes mellitus, diabetic cardiomyopathy, and impaired respiratory response to hypoxia and hypercapnea. We conclude that diabetes mellitus does appear to be associated with an increased risk of sudden cardiac death. Although this increased risk is relatively modest, given the large number of diabetic patients worldwide, the absolute number of sudden cardiac deaths attributable to diabetes mellitus remains significant. Little evidence exists to support any specific mechanism(s) accounting for this association. Further investigation into the pathophysiology of sudden cardiac death in diabetes mellitus may yield improved risk stratification tools as well as identify novel therapeutic targets.
糖尿病与心脏性猝死风险增加长期相关。然而，这种关联的程度及其发生机制尚未明确。本综述评估了糖尿病与心脏性猝死之间关联的流行病学数据，并讨论了可能解释这种关系的各种机制。导致糖尿病患者心脏性猝死风险增加的潜在因素包括无症状性心肌缺血、自主神经功能障碍、心脏复极异常、低血糖、糖尿病继发的高凝状态、糖尿病性心肌病以及对缺氧和高碳酸血症的呼吸反应受损。我们得出结论，糖尿病确实与心脏性猝死风险增加相关。尽管这种风险增加相对较小，但考虑到全球大量的糖尿病患者，糖尿病导致的心脏性猝死绝对数量仍然显著。目前几乎没有证据支持任何特定机制可以解释这种关联。进一步研究糖尿病心脏性猝死的病理生理学可能会产生更好的风险分层工具，并确定新的治疗靶点。
