QT interval, cardiovascular risk factors and risk of death in diabetes

Veglio, M; Chinaglia, Alessandra; Cavallo‐Perin, P.

doi:10.1007/bf03346265

Cited by 123 publications

(96 citation statements)

References 48 publications

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“…Further, a negative correlation between QTc time and HbA 1c was present in our patients without QTc-prolonging drugs, suggesting a plausible association between these two risk factors. QTc prolongation, a condition known to be associated with CAN, has been shown to increase the risk of arrhythmia and sudden death in diabetic patients [41,42]. In the ACCORD trial, the presence of CAN, defined as a combination of pathological QT index and abnormal heart-rate variability, was associated with increased mortality risk [43].…”

Section: Discussionmentioning

confidence: 99%

The impact of metabolic control and QTc prolongation on all-cause mortality in patients with type 2 diabetes and foot ulcers

Fagher

Löndahl

2013

Diabetologia

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Aims/hypothesis The increased all-cause mortality in patients with chronic diabetic foot ulcers cannot fully be explained by traditional cardiovascular risk factors. The significance of heart-rate-corrected QT (QTc) prolongation, a finding often seen in these patients, is unknown. Recently, the importance of metabolic control and hypoglycaemia has been discussed. The aim of this study was to evaluate the impact of different HbA 1c levels and QTc prolongation on all-cause mortality in the high-risk population of patients with type 2 diabetes mellitus and foot ulcers. Methods All patients with type 2 diabetes, younger than 80 years, visiting our diabetes foot unit, with a foot ulcer duration >4 weeks, were screened for participation. Patients on dialysis were excluded. Patients were grouped according to HbA 1c level and QTc time ≤ or >440 ms. Results Patients (n=214, median age 69.1 years) were grouped according to HbA 1c level (HbA 1c <7.5% [<58 mmol/mol] n=81, 7.5-8.9% [58-74 mmol/mol] n=70, >8.9% [>74 mmol/ mol] n=63). Baseline characteristics, including use of potential hypoglycaemic drugs, were similar between groups. During the 8 years of follow-up 151 patients died (70.6%) and HbA 1c < 7.5% (<58 mmol/mol) was strongly associated with increased mortality. The highest mortality was seen in patients with a combination of HbA 1c <7.5% (<58 mmol/mol) and QTc prolongation, with an 8 year mortality of 92.1% as compared with 48.8% in those with HbA 1c < 7.5% (<58 mmol/mol) but without QTc prolongation. Conclusion/interpretations HbA 1c <7.5% (<58 mmol/mol) in a high-risk population of patients with type 2 diabetes and foot ulcers is associated with a significantly higher mortality, particularly in patients with QTc prolongation.

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Section: Discussionmentioning

confidence: 99%

The impact of metabolic control and QTc prolongation on all-cause mortality in patients with type 2 diabetes and foot ulcers

Fagher

Löndahl

2013

Diabetologia

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“…For diabetic patients, the most prominent cardiac electrical disturbance is an abnormal QT interval, which is associated with increased risk of sudden cardiac death (Refs 171,172). QT interval is the total duration for ventricular depolarisation and repolarisation of cardiac myocytes, which is controlled by the flow of inward and outward ion currents.…”

Section: Mirnas Associated With Diabetic Heartmentioning

confidence: 99%

Molecular medicine of microRNAs: structure, function and implications for diabetes

Hennessy

O’Driscoll²

2008

Expert Rev. Mol. Med.

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MicroRNAs (miRNAs) are a family of endogenous small noncoding RNA molecules, of 19–28 nucleotides in length. In humans, up to 3% of all genes are estimated to encode these evolutionarily conserved sequences. miRNAs are thought to control expression of thousands of target mRNAs. Mammalian miRNAs generally negatively regulate gene expression by repressing translation, possibly through effects on mRNA stability and compartmentalisation, and/or the translation process itself. An extensive range of in silico and experimental techniques have been applied to our understanding of the occurrence and functional relevance of such sequences, and antisense technologies have been successfully used to control miRNA expression in vitro and in vivo. Interestingly, miRNAs have been identified in both normal and pathological conditions, including differentiation and development, metabolism, proliferation, cell death, viral infection and cancer. Of specific relevance and excitement to the area of diabetes research, miRNA regulation has been implicated in insulin secretion from pancreatic β-cells, diabetic heart conditions and nephropathy. Further analyses of miRNAs in vitro and in vivo will, undoubtedly, enable us determine their potential to be exploited as therapeutic targets in diabetes.

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“…1 Cardiac dysautonomia often associated with peripheral neuropathies in T2DM contributes to the electrical instability of the myocardium. 2 Additionally, silent myocardial ischemia has been shown to be associated with cardiac autonomic neuropathy in T2DM, thus amplifying the risk of arrhythmia and cardiac events.…”

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confidence: 99%

Diabetic Neuropathy Is a More Important Determinant of Baroreflex Sensitivity Than Carotid Elasticity in Type 2 Diabetes

et al. 2005

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Abstract-The object of this study was to evaluate the contribution of carotid distensibilty on baroreflex sensitivity in patients with type 2 diabetes mellitus with at least 2 additional cardiovascular risk factors. Carotid distensibility was measured bilaterally at the common carotid artery in 79 consecutive diabetic patients and 60 matched subjects without diabetes. Spontaneous baroreflex sensitivity assessment was obtained using time and frequency methods. Baroreflex sensitivity was lower in diabetic subjects as compared with nondiabetic control subjects (5.25Ϯ2.80 ms/mm Hg versus 7.55Ϯ3.79 ms/mm Hg; PϽ0.01, respectively). Contrary to nondiabetic subjects, diabetic subjects showed no significant correlation between carotid distensibility and baroreflex sensitivity (r 2 ϭ0.08, Pϭ0.04 and r 2 ϭ0.04, Pϭ0.13, respectively). In diabetic subjects, baroreflex sensitivity was significantly lower in subjects with peripheral neuropathy than in those with preserved vibration sensation (4.1Ϯ0.5 versus 6.1Ϯ0.4 ms/mm Hg, respectively; Pϭ0.005). Age in nondiabetic subjects, diabetes duration, systolic blood pressure, peripheral or sensitive neuropathy, and carotid distensibility were introduced in a stepwise multivariate analysis to identify the determinants of baroreflex sensitivity. In diabetic patients, neuropathy is a more sensitive determinant of baroreflex sensitivity than the reduced carotid distensibility (stepwise analysis; F ratioϭ5.1, Pϭ0.028 versus F ratioϭ1.9, Pϭ0.16, respectively). In diabetic subjects with 2 additional cardiovascular risk factors, spontaneous baroreflex sensitivity is not related to carotid distensibility. Diabetic subjects represent a particular population within the spectrum of cardiovascular risk situations because of the marked neuropathy associated with their metabolic disorder. Therefore, neuropathy is a more significant determinant of baroreflex sensitivity than carotid artery elasticity in patients with type 2 diabetes.

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QT interval, cardiovascular risk factors and risk of death in diabetes

Cited by 123 publications

References 48 publications

The impact of metabolic control and QTc prolongation on all-cause mortality in patients with type 2 diabetes and foot ulcers

The impact of metabolic control and QTc prolongation on all-cause mortality in patients with type 2 diabetes and foot ulcers

Molecular medicine of microRNAs: structure, function and implications for diabetes

Diabetic Neuropathy Is a More Important Determinant of Baroreflex Sensitivity Than Carotid Elasticity in Type 2 Diabetes

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