Increased CVD Risk With ECG Abnormalities in Type 1 Diabetes

Electrocardiography (ECG) abnormalities may predict cardiovascular (CVD) risk in patients with type 1 diabetes, according to a study published in Diabetes Care.¹

Patients with type 1 diabetes are at increased risk for CVD, the leading cause of death in this population.^2,3- In the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study, the majority of patients with type 1 diabetes developed new ECG abnormalities, and 1 in 6 participants acquired at least 1 new major ECG abnormality over a period of  16 years.⁴

Limited data suggest that ECG abnormalities may be associated with a greater risk for CVD in patients with type 1 diabetes.¹

In the EDIC observational study, Elsayed Z. Soliman, MD, from  Wake Forest School of Medicine in Winston-Salem, North Carolina, and colleagues evaluated the relationship between ECG abnormalities and CVD events in patients with type 1 diabetes.¹

Based on the Minnesota Code ECG classification, ECG abnormalities were categorized as major (eg, complete left or right bundle branch block), minor (eg, isolated minor T wave or ST-segment abnormalities), or no abnormality. CVD events included stroke, congestive heart failure, first myocardial infarction, confirmed angina, coronary artery revascularization, or CVD-related death.¹

Of 1306 patients, 155 (11.9%) experienced 1 or more CVD events during a median follow-up time of 19 years. Major ECG abnormalities predicted a more than 2-fold greater risk of CVD events compared with no abnormality (hazard ratio [HR] 2.10; 95% CI, 1.26-3.48) and no major abnormality (HR: 2.19; 95% CI, 1.46-3.29). Gender and HbA1c did not influence this risk.¹

CVD risk associated with major ECG abnormalities was cumulative and increased with the development of each additional major ECG abnormality. Furthermore, the longer a major ECG abnormality was present, the higher the risk of CVD, with a 30% increased risk of CVD per year (HR: 1.30; 95% CI, 1.14-1.48).¹

Minor ECG abnormalities did not significantly correlate with increased CVD risk.¹

“A simple test like ECG could be a useful tool for screening patients with type 1 diabetes to identify those who are at risk for developing CVD in the future,” Dr Soliman said in an interview with Cardiology Advisor.

“However, further research is needed for 2 reasons: first, to confirm these results; and second, to examine the cost-effectiveness of such an approach,” he added.

Reference

1.       Soliman EZ, Backlund JC, Bebu I, Orchard TJ, Zinman B, Lachin JM; DCCT/EDIC Research Group. Electrocardiographic abnormalities and cardiovascular disease risk in type 1 diabetes: the Epidemiology of Diabetes Interventions and Complications (EDIC) study [Published online March 6, 2017]. Diabetes Care. doi:10.2337/dc16-2050 

2.       de Ferranti SD, de Boer IH, Fonseca V, et al. Type 1 diabetes mellitus and cardiovascular disease: a scientific statement from the American Heart Association and American Diabetes Association. Diabetes Care. 2014;37(10):2843-2863. doi:10.2337/dc14-1720

3.       Secrest AM, Becker DJ, Kelsey SF, Laporte RE, Orchard TJ. Cause-specific mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes. Diabetes. 2010;59(12):3216-3222. doi:10.2337/db10-0862

4.       Soliman EZ, Backlund JY, Bebu I, et al; DCCT/EDIC Research Group. Progression of electrocardiographic abnormalities in type 1 diabetes during 16 years of follow-up: the Epidemiology of Diabetes Interventions and Complications (EDIC) study. J Am Heart Assoc. 2016;5(3):e002882. doi:10.1161/JAHA.115.002882