Causes of Death in a Contemporary Cohort of Patients With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease: Insights From the TECOS Trial.
Sharma A., Green JB., Dunning A., Lokhnygina Y., Al-Khatib SM., Lopes RD., Buse JB., Lachin JM., Van de Werf F., Armstrong PW., Kaufman KD., Standl E., Chan JCN., Distiller LA., Scott R., Peterson ED., Holman RR., TECOS Study Group None.
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 [MIn= 48, stroken= 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.