Abhinav Sharma1,2, Jennifer B Green3, Allison Dunning3, Yuliya Lokhnygina3, Sana M Al-Khatib3, Renato D Lopes3, John B Buse4, John M Lachin5, Frans Van de Werf6, Paul W Armstrong2, Keith D Kaufman7, Eberhard Standl8, Juliana C N Chan9, Larry A Distiller10, Russell Scott11, Eric D Peterson3, Rury R Holman12. 1. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC a.sharma@duke.edu. 2. Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. 3. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. 4. University of North Carolina School of Medicine, Chapel Hill, NC. 5. George Washington University Biostatistics Center, Rockville, MD. 6. University of Leuven, Leuven, Belgium. 7. Merck & Co., Inc., Kenilworth, NJ. 8. Munich Diabetes Research Group, Helmholtz Centre, Neuherberg, Germany. 9. Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong. 10. Centre for Diabetes and Endocrinology, Johannesburg, South Africa. 11. Don Beaven Medical Research Centre, Christchurch Hospital, Christchurch, New Zealand. 12. Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, U.K.
Abstract
OBJECTIVE: We evaluated the specific causes of death and their associated risk factors in a contemporary cohort of patients with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD). RESEARCH DESIGN AND METHODS: We used data from the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) study (n = 14,671), a cardiovascular (CV) safety trial adding sitagliptin versus placebo to usual care in patients with type 2 diabetes and ASCVD (median follow-up 3 years). An independent committee blinded to treatment assignment adjudicated each cause of death. Cox proportional hazards models were used to identify risk factors associated with each outcome. RESULTS: A total of 1,084 deaths were adjudicated as the following: 530 CV (1.2/100 patient-years [PY], 49% of deaths), 338 non-CV (0.77/100 PY, 31% of deaths), and 216 unknown (0.49/100 PY, 20% of deaths). The most common CV death was sudden death (n = 145, 27% of CV death) followed by acute myocardial infarction (MI)/stroke (n = 113 [MI n = 48, stroke n = 65], 21% of CV death) and heart failure (HF) (n = 63, 12% of CV death). The most common non-CV death was malignancy (n = 154, 46% of non-CV death). The risk of specific CV death subcategories was lower among patients with no baseline history of HF, including sudden death (hazard ratio [HR] 0.4; P = 0.0036), MI/stroke death (HR 0.47; P = 0.049), and HF death (HR 0.29; P = 0.0057). CONCLUSIONS: In this analysis of a contemporary cohort of patients with diabetes and ASCVD, sudden death was the most common subcategory of CV death. HF prevention may represent an avenue to reduce the risk of specific CV death subcategories.
RCT Entities:
OBJECTIVE: We evaluated the specific causes of death and their associated risk factors in a contemporary cohort of patients with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD). RESEARCH DESIGN AND METHODS: We used data from the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) study (n = 14,671), a cardiovascular (CV) safety trial adding sitagliptin versus placebo to usual care in patients with type 2 diabetes and ASCVD (median follow-up 3 years). An independent committee blinded to treatment assignment adjudicated each cause of death. Cox proportional hazards models were used to identify risk factors associated with each outcome. RESULTS: A total of 1,084 deaths were adjudicated as the following: 530 CV (1.2/100 patient-years [PY], 49% of deaths), 338 non-CV (0.77/100 PY, 31% of deaths), and 216 unknown (0.49/100 PY, 20% of deaths). The most common CV death was sudden death (n = 145, 27% of CV death) followed by acute myocardial infarction (MI)/stroke (n = 113 [MI n = 48, stroke n = 65], 21% of CV death) and heart failure (HF) (n = 63, 12% of CV death). The most common non-CV death was malignancy (n = 154, 46% of non-CV death). The risk of specific CV death subcategories was lower among patients with no baseline history of HF, including sudden death (hazard ratio [HR] 0.4; P = 0.0036), MI/stroke death (HR 0.47; P = 0.049), and HF death (HR 0.29; P = 0.0057). CONCLUSIONS: In this analysis of a contemporary cohort of patients with diabetes and ASCVD, sudden death was the most common subcategory of CV death. HF prevention may represent an avenue to reduce the risk of specific CV death subcategories.
Authors: Abhinav Sharma; Adrian Coles; Nishant K Sekaran; Neha J Pagidipati; Michael T Lu; Daniel B Mark; Kerry L Lee; Hussein R Al-Khalidi; Udo Hoffmann; Pamela S Douglas Journal: J Am Coll Cardiol Date: 2019-03-05 Impact factor: 24.094
Authors: Abhinav Sharma; Jingjing Wu; Haolin Xu; Adrian Hernandez; G Michael Felker; Sana Al-Khatib; Jennifer Green; Roland Matsouaka; Gregg C Fonarow; Jagmeet P Singh; Paul A Heidenreich; Justin A Ezekowitz; Adam DeVore Journal: J Am Heart Assoc Date: 2020-05-30 Impact factor: 5.501
Authors: Subodh Verma; Abhinav Sharma; Bernard Zinman; Anne Pernille Ofstad; David Fitchett; Martina Brueckmann; Christoph Wanner; Isabella Zwiener; Jyothis T George; Silvio E Inzucchi; Javed Butler; C David Mazer Journal: Diabetes Obes Metab Date: 2020-03-29 Impact factor: 6.577