Abstract P049: Premature Ventricular Complexes Predict Mortality in a Population with Type 2 Diabetes - The Diabetes Heart Study
BACKGROUND: Premature ventricular complexes (PVCs) are a common electrocardiographic finding in the general population with or without known cardiovascular disease. Previous population based studies suggest an association of PVCs with increased risk of all-cause and cardiovascular mortality. Diabetes is a cardiovascular disease risk equivalent due to its association with increased cardiovascular morbidity and mortality. However, among type 2 diabetics it is not well-defined which individuals are at a higher risk for adverse outcomes.
METHODS: We studied 1120 individuals with type 2 diabetes (83% Caucasians, 54% women, mean age: 62 years) who were not taking antiarrhythmic therapy at baseline. Significant PVCs was defined as 10% or more of recorded complexes on a standard 10 seconds surface electrocardiogram (ECG). Kaplan Meier (KM) survival analysis was used to compare the groups with and without significant PVCs. Cox proportional hazard analysis was used to examine the association between significant PVCs and all-cause and cardiovascular mortality after adjustment for covariates.
RESULTS: At baseline, the prevalence of significant PVCs was 3.5% (n=39) in the entire cohort. After a median follow up of 8.5 years (maximum: 14 years), 246 (22%) died of any cause and 107 (9.5%) died of cardiovascular disease (CVD). Participants with significant PVCs had worse survival (KM log rank p <0.001 for both all-cause and CVD mortality). In a multivariate model, presence of significant PVCs was associated with increased risk of all-cause mortality after adjusting for age, ethnicity, gender, systolic blood pressure, use of hypertension medications, body mass index, current smoking, LDL and HDL cholesterol, triglyceride, estimated glomerular filtration rate, and history of prior CVD [HR (95%CI): 1.85 (1.08-3.18), p=0.026]. Similar results were obtained for the outcome of CVD mortality in a fully adjusted model [HR (95%C): 2.28 (1.07-4.86), p=0.033]. Further adjustment for diabetes duration and severity did not significantly affect these results.
CONCLUSION: Significant PVCs on a resting surface ECG are an independent predictor of all-cause and CVD mortality in this cohort of type 2 diabetics. These findings suggest that this simple, non-invasive test can provide important prognostic information despite the presence of type 2 diabetes. More data is needed to identify optimal prevention strategies in such high risk patients with type 2 diabetes.
- © 2013 by American Heart Association, Inc.