Heart Rate–Corrected QT Interval Is an Independent Predictor of All-Cause and Cardiovascular Mortality in Individuals With Type 2 Diabetes: The Diabetes Heart Study

Cox, Amanda J.; Azeem, Amir; Yeboah, Joseph; Soliman, Elsayed Z.; Aggarwal, Shivani; Bertoni, Alain G.; Freedman, Barry I.; Herrington, David M.; Bowden, Donald W.

doi:10.2337/dc13-1257

Cited by 78 publications

(80 citation statements)

References 40 publications

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“…Moreover, increased dispersion of ventricular repolarization occurs in diabetic patients5, 6, 7, 8, 10 with an important implication on propensity to develop electrical disturbances 4, 13, 15, 16. To test the possibility that prolonged electrical recovery with hyperglycemia was associated with increased repolarization variability and rhythm disturbances, the degree of temporal dispersion of myocardial repolarization and susceptibility to develop arrhythmias were quantified.…”

Section: Resultsmentioning

confidence: 99%

“…Prolongation of the QT interval and increased dispersion of repolarization have been observed in the diabetic population,4, 5, 6, 7, 8, 9, 10 and these variables, together with intervening comorbidities,11 represent critical substrates for the occurrence of electrical disturbances 4, 12, 13, 14, 15, 16, 17. But whether alterations at the cellular level contribute to protracted electrical recovery and repolarization variability with diabetes remain to be determined.…”

Section: Introductionmentioning

confidence: 99%

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Reduction in Kv Current Enhances the Temporal Dispersion of the Action Potential in Diabetic Myocytes: Insights From a Novel Repolarization Algorithm

Meo

Meste

Signore

et al. 2016

JAHA

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BackgroundDiabetes is associated with prolongation of the QT interval of the electrocardiogram and enhanced dispersion of ventricular repolarization, factors that, together with atherosclerosis and myocardial ischemia, may promote the occurrence of electrical disorders. Thus, we tested the possibility that alterations in transmembrane ionic currents reduce the repolarization reserve of myocytes, leading to action potential (AP) prolongation and enhanced beat‐to‐beat variability of repolarization.Methods and ResultsDiabetes was induced in mice with streptozotocin (STZ), and effects of hyperglycemia on electrical properties of whole heart and myocytes were studied with respect to an untreated control group (Ctrl) using electrocardiographic recordings in vivo, ex vivo perfused hearts, and single‐cell patch‐clamp analysis. Additionally, a newly developed algorithm was introduced to obtain detailed information of the impact of high glucose on AP profile. Compared to Ctrl, hyperglycemia in STZ‐treated animals was coupled with prolongation of the QT interval, enhanced temporal dispersion of electrical recovery, and susceptibility to ventricular arrhythmias, defects observed, in part, in the Akita mutant mouse model of type I diabetes. AP was prolonged and beat‐to‐beat variability of repolarization was enhanced in diabetic myocytes, with respect to Ctrl cells. Density of Kv K+ and L‐type Ca2+ currents were decreased in STZ myocytes, in comparison to cells from normoglycemic mice. Pharmacological reduction of Kv currents in Ctrl cells lengthened AP duration and increased temporal dispersion of repolarization, reiterating features identified in diabetic myocytes.ConclusionsReductions in the repolarizing K+ currents may contribute to electrical disturbances of the diabetic heart.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reduction in Kv Current Enhances the Temporal Dispersion of the Action Potential in Diabetic Myocytes: Insights From a Novel Repolarization Algorithm

Meo

Meste

Signore

et al. 2016

JAHA

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“…In the European Diabetes (EURODIAB) Prospective Complications Study of 1415 people with T1DM, the benefits of mild or vigorous intensity weekly physical activity on preventing the development of a biomarker of cardiovascular disease 269,270 were significant only in men (mild activity: adjusted OR=0.27; 95% CI, 0.10-0.76; vigorous activity: adjusted OR=0.38; 95% CI, 0.14-0.99), not in women (mild activity: adjusted OR=0.74; 95% CI, 0.28-1.96; vigorous activity: adjusted OR=0.54; 95% CI, 0.19-1.49). 271 No test for effect modification by sex was reported.…”

Section: Cardiovascular Eventsmentioning

confidence: 99%

Sex Differences in the Cardiovascular Consequences of Diabetes Mellitus

et al. 2015

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Currently, ≈1 in 13 people living in the United States has DM, and 90% to 95% of these individuals have type 2 DM (T2DM).2 Overall, the prevalence of T2DM is similar in women and men. In the United States, ≈12.6 million women (10.8%) and 13 million men (11.8%) ≥20 years of age are currently estimated to have T2DM. 2 Among individuals with T2DM, cardiovascular disease (CVD) is the leading cause of morbidity and mortality and accounts for >75% of hospitalizations and >50% of all deaths.3 Although nondiabetic women have fewer cardiovascular events than nondiabetic men of the same age, this advantage appears to be lost in the context of T2DM. 4,5 The reasons for this advantage are not entirely clear but are likely multifactorial with contributions from inherent physiological differences, including the impact of the sex hormones, differences in cardiovascular risk factors, and differences between the sexes in the diagnosis and treatment of DM and CVD. 6 In addition, there are racial and ethnic factors to consider because women of ethnic minority backgrounds have a higher prevalence of DM than non-Hispanic white (NHW) women.This scientific statement was designed to provide the current state of knowledge about sex differences in the cardiovascular consequences of DM, and it will identify areas that would benefit from further research because much is still unknown about sex differences in DM and CVD. Areas that are discussed include hormonal differences between the sexes and their possible effects on the interaction between DM and CVD, sex differences in epidemiology, ethnic and racial differences and risk factors for CVD in DM across the life span, sex differences in various types of CVD and heart failure, and sex differences in the effects of treatments for DM, including both medications and lifestyle. In addition, there is discussion about risk factors that are specific to women, including gestational diabetes mellitus (GDM) and polycystic ovarian syndrome (PCOS), which affect CVD risk. Table 1 focuses on sex differences in CVD risk factors and outcomes in DM, and Table 2 provides information about sex differences in CVD treatments and interventions in DM. Table 3 contains some of the important ideas for research in sex differences in the cardiovascular consequences of DM. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on July 31, 2015, and the American Heart Association Executive Committee on September 5, 2015. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By...

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“…At the start of the study, 3.0 % of all the patients had a prolonged QTc interval (mean interval 414.9 ± 18.1 ms). In the adjusted analysis of multivariance, the prolongation of the QTc interval by a standard deviation was associated with 18 % higher total mortality risk (HR 1.18 [95 % CI 1.03-1.36]) and a 29 % higher risk of cardiovascular mortality (1.29 [1.05-1.59]) (21).…”

Section: Treatment Options: Preventing Complicationsmentioning

confidence: 99%

Diabetic foot syndrome in elderly patients

Eckert¹

2017

Phlebologie

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SummaryIn elderly patients with diabetes mellitus and mild deterioration of the lower extremities, peripheral artery disease and diabetic peripheral neuropathy may contribute to the development of a diabetic foot syndrome. Early diagnosis and intervention can help to preserve the foot and thus significantly increase quality of life with diagnostic and therapeutic procedures being the same in elderly and in young patients.Non-invasive diagnosis is possible in most bed-ridden patients and should take into account reasonable therapeutic options against the background of overall morbidity, physical performance and quality of life, which should be discussed with the patient and his relatives. Multidisciplinary care structures facilitate treatment and might lead to reduced amputation rates and an improved well-being.

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Heart Rate–Corrected QT Interval Is an Independent Predictor of All-Cause and Cardiovascular Mortality in Individuals With Type 2 Diabetes: The Diabetes Heart Study

Cited by 78 publications

References 40 publications

Reduction in Kv Current Enhances the Temporal Dispersion of the Action Potential in Diabetic Myocytes: Insights From a Novel Repolarization Algorithm

Reduction in Kv Current Enhances the Temporal Dispersion of the Action Potential in Diabetic Myocytes: Insights From a Novel Repolarization Algorithm

Sex Differences in the Cardiovascular Consequences of Diabetes Mellitus

Diabetic foot syndrome in elderly patients

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