Dataset Information

Hemoglobin A1c levels and risk of sudden cardiac death: A nested case-control study.

ABSTRACT: BACKGROUND:Sudden cardiac death (SCD) is often the first manifestation of cardiovascular disease (CVD), and preventive strategies within this broad population are lacking. Patients with diabetes represent a high-risk subgroup, but few data exist regarding whether measures of glycemia mediate risk and/or add to SCD risk stratification. OBJECTIVE:The purpose of this study was to examine the association between hemoglobin A1c (HbA1c) and SCD. METHODS:We performed a case-control analysis among individuals enrolled in 6 prospective cohort studies. HbA1c levels were determined for 482 cases of SCD and 914 matched controls. Conditional logistic regression with fixed effects meta-analysis was used for analysis. RESULTS:In multivariable models, HbA1c levels were linearly associated with SCD risk over follow-up of 11.3 years (P <.001). Each 1% increment in HbA1c was associated with a hazard ratio (HR) of 1.32 (95% confidence interval [CI] 1.16-1.50). The magnitude of the association was greater in subjects without vs those with known CVD [HR per 1% increment 1.64 (95% CI 1.31-2.06) vs 1.15 (95% CI 0.99-1.33), P interaction = .009]. In models simultaneously controlling for diabetes status and HbA1c, the association between HbA1c and SCD remained significant (HR 1.29, 95% CI 1.07-1.55, P = .01), whereas the association between diabetes and SCD was attenuated (relative risk 1.21, 95% CI 0.64-2.27, P = .56). CONCLUSION:In these prospective cohorts, HbA1c levels associated with SCD risk, particularly among those without known CVD, even after controlling for diabetes status. These data support the hypothesis that hyperglycemia mediates SCD risk among patients with diabetes.

SUBMITTER: Patel RB

PROVIDER: S-EPMC5754013 | biostudies-literature | 2017 Jan

REPOSITORIES: biostudies-literature

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Hemoglobin A<sub>1c</sub> levels and risk of sudden cardiac death: A nested case-control study.

Patel Ravi B RB Moorthy M V MV Chiuve Stephanie E SE Pradhan Aruna D AD Cook Nancy R NR Albert Christine M CM

Heart rhythm 20160831 1

<h4>Background</h4>Sudden cardiac death (SCD) is often the first manifestation of cardiovascular disease (CVD), and preventive strategies within this broad population are lacking. Patients with diabetes represent a high-risk subgroup, but few data exist regarding whether measures of glycemia mediate risk and/or add to SCD risk stratification.<h4>Objective</h4>The purpose of this study was to examine the association between hemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>) and SCD.<h4>Methods</h4>We p ...[more]

PMID: 27591826

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Project description:Epidemiological studies have linked domperidone use with serious cardiac arrhythmias, including sudden cardiac death, but data on age, dose, and duration of use are limited.The aim of this study was to assess the risk of out-of-hospital sudden cardiac death associated with domperidone use versus proton pump inhibitors (PPIs), metoclopramide, or non-use of all three medications, and to evaluate the risk of sudden cardiac death in relation to age and domperidone dose.This was a population-based case-control study nested in a cohort of subjects aged ?2 years in the Clinical Practice Research Datalink with one or more prescriptions for domperidone, any PPI, or metoclopramide from 2005 to 2011. Out-of-hospital sudden cardiac death was assessed by linkage with Hospital Episode Statistics and death certificates. Controls were matched on age, sex, and medical practice. The risk of sudden cardiac death in domperidone users versus risk in users of PPIs or metoclopramide was evaluated with multivariable conditional logistic regression; case-crossover analysis addressed possible residual confounding.From the study cohort (n = 681,104), 3239 sudden cardiac death cases were matched to 12,572 controls. The adjusted odds ratio (95 % confidence interval) for sudden cardiac death with current use of domperidone alone was 1.71 (0.92-3.18) versus non-use of study medications, 1.26 (0.68-2.34) versus current PPI use, and 0.40 (0.17-0.94) current metoclopramide use. The adjusted odds ratio (95 % confidence interval) relative to exposure to no study drug for domperidone >30 mg/day (eight cases, five controls) was 3.20 (0.59-17.3) and 1.65 (0.89-3.07) for age ?61 years (27 cases, 49 controls). The odds ratio (95 % confidence interval) was 3.17 (1.72-5.83) for within-person periods of domperidone use versus non-use in the case-crossover analysis.Compared with non-use of any study drug, current domperidone use was associated with sudden cardiac death in nested case-control and case-crossover analyses, with a suggestion of higher risk in older persons and users of higher daily doses.

Dataset Information

Hemoglobin A1c levels and risk of sudden cardiac death: A nested case-control study.

Publications

Hemoglobin A<sub>1c</sub> levels and risk of sudden cardiac death: A nested case-control study.

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