Diabetes, glucose level, and risk of sudden cardiac death

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Abstract
Aims The prevalence of diabetes mellitus in industrialized countries is rapidly increasing, and diabetes is suspected to carry a particular high risk for sudden cardiac death (SCD). Methods and results We conducted a population-based case–control study at Group Health Cooperative. Cases (n=2040) experienced out-of-hospital cardiac arrest due to heart disease between 1980 and 1994. Controls (n=3800) were a stratified random sample of enrollees. Diabetes status was classified into four exclusive groups: (i) no diabetes, (ii) borderline, (iii) diabetes without microvascular disease (retinopathy or proteinuria), and (iv) diabetes with microvascular disease. When compared with no diabetes, we observed progressively higher risk of SCD associated with borderline diabetes [Odds ratio (OR)=1.24 (0.98–1.57)], diabetes without microvascular disease [OR=1.73 (1.28–2.34)], and diabetes with microvascular disease [OR=2.66 (1.84–3.85)], after adjustment for potential confounders (P-value for trend Conclusion These results emphasize the role of diabetes as a strong risk factor for SCD and outline the importance of glucose level at every stage of diabetes severity.