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    Nemtsova V. D.


    About the author: Nemtsova V. D.
    Type of article Review article
    Annotation Diabetes mellitus is one of the most important medical and social problems in the world today. It is considered that the life expectancy of the patients with diabetes mellitus is 10 years less than those without metabolic disturbance and the leading cause of death are cardiovascular diseases, including sudden cardiac death which is about 50%, which was confirmed by numerous studies. However, till nowadays is not quite clear what is the cause of the increased risk of sudden death in these patients. This literature review devoted to the analysis of recent data on the possible causes of sudden death in patients with diabetes mellitus: a combination with coronary artery disease, left ventricular dysfunction, the role of hypoglycemia provoked arrhythmias, diabetic autonomic neuropathy development. It is known that in a population of the patients with myocardial infarction, diabetes mellitus increases the risk of sudden cardiac death. In addition, diabetes increases the risk of sudden cardiac death in patients with myocardial infarction and concomitant heart failure. Difficulty of coronary artery disease diagnosing in patients with diabetes is due to its frequent asymptomatic and atypical course. It is painless myocardial infarction is one of the causes of sudden death in patients with diabetes mellitus. The results of the Framingham study (2003) suggests that diabetes mellitus occurs the early development of left ventricular diastolic dysfunction, which leads to enlargement of left atrium, increasing the likelihood of arrhythmias. These data confirm the view that the relationship of diabetes and sudden cardiac death lies in the arrhythmogenic nature of diabetes. On the other hand, diabetes significantly increases the risk of cardiomyopathy with relevant mitochondrial dysfunction in pathogenesis, activation of fatty acid oxidation and other pathological processes whose activity depends on the activity of cellular metabolism and disorders of glucose metabolism associated with hypoglycemic episodes. However, nowadays despite the sufficient amount of investigations there is no conclusive evidence about the benefits of intensive glycemic control in order to reduce the incidence of cardiovascular events. Moreover, several studies have demonstrated the negative impact of strict control of glycemia on mortality. The is important to mark that not only lower blood glucose levels affects the occurrence of acute cardiac death, but hyperglycemia and a high daily blood glucose variation. Another predisposing factor for sudden cardiac death is diabetic cardiovascular autonomic neuropathy - pathological changes in the autonomic nervous system regulation of cardiac activity with a predominance of sympathetic influences and / or a decrease in vagal activity, which is observed in 22% of patients with type 2 diabetes and is considered a poor prognostic factor associated with increased incidence of sudden cardiac death. Summarizing accumulated till nowadays data, it is important to note that despite the fact that some risk factors for sudden death, such as microvascular pathology, autonomic neuropathy, expressed glycemic imbalance can be specific associated with diabetes in the recent recommendations of the European Society Cardiology and the European Association for the Study of Diabetes indicates that there is no conclusive data to create stratificational schemes and recommendations to prevent sudden cardiac death in diabetes. Therefore, greater emphasis should be placed on the proven risk factors for sudden cardiac death - the primary prevention of diabetes, atherosclerosis and coronary heart disease and secondary prevention of cardiovascular complications.
    Tags diabetes mellitus,sudden death, risk factors
    • Ametov A. S. Serdechno-sosudistye riski pri saharnomdiabete / A. S. Ametov, E. Ja. Parnes, N. A. Cherikova [i dr.] // Jendokrinologija – 2013 -№2.
    • Borovkov N. N. Vzaimosvjaz' pokazatelej sutochnogo profilja arterial'nogo davlenija i variabel'nosti ritma serdca u bol'nyh arterial'noj gipertenziej i insulin nezavisimym saharnym diabetom / N.N.Borovkov, N.V. Sidorova // - 2002. - № 7. - S. 19-21.
    • Masljaeva L. V. Narushenieritma i provodimostiserdca u bol'nyh s gipertonicheskojbolezn'ju i soputstvujushhimsaharnymdiabetom 2 tipa / L. V. Masljaeva, T. G. Starchenko // - M., - 2005. - S. 72-74.
    • Nesterova I. V. Aritmologicheskaja harakteristika bol'nyh s hronicheskoj serdechnoj nedostatochnost'ju pri sohranennom sinusovom ritme i podhody k ee uluchsheniju / I. V. Nesterova, E. A. Ljasnikova, M. Ju. Sitnikova [i dr.] // Vestnik aritmologii. - 2004- N31.-C. 20-25.
    • Pan'kiv V. I. Klinicheskie aspekty gipoglikemii kak faktora riska serdechno-sosudistyhoslozhnenij pri saharnomdiabete 2-go tipa / V. I. Pan'kiv // Mezhdunarodnyj jendokrinologicheskij zhurnal.-2011.-№5(37).
    • Javelov I. S. Vnezapnaja serdechnaja smert' pri metabolicheskom sindrome / I.S. Javelov // Trudnyj pacient.-2012.7. Аlbert C. M. Prospective study of sudden cardiac death among women in the United States / C.M. Аlbert, C.U. Chae, F. Grodstein [et al.] //Circulation-2003-№107 - Р. 2096 – 2101.
    • Azuma K. Repetitive fluctuations in blood glucose enhance monocyte adhesion to the endothelium of rat thoracic aorta / K. Azuma, R. Kowamori, Y. Toyofuku [et al.] // Arteriscler. Thromb.Vasc. Biol. - 2006. - Vol. 26. - P. 2275-2280.
    • Benfante A. U. To what extent do cardiovascular risk factor values measured in elderly men represent their midlife values measured 25 years earlier? A preliminary report and commentary from the Honolulu Heart Program / A.U. Benfante, L. J. Hwang, K. Masaki [et al.] //Am J Epidemiol -1994 –V/140(3) – 206 p.
    • Capone R. J. Events in the cardiac arrhythmia suppression trial: baseline predictors of mortality in placebo-treated patients / R.J. Capone, N. Pawitan // J. Am. Coll. Cardiol. - 1991. - Vol. 18. - P. 1434-1458.
    • Сoutinho M. The relations hipbetween glucose and incident cardio vasculare vents: a meta regression analysis of published data from 20 studiesof 95,783 individuals followedfor 12.4 years / M. Сoutinho, H.C. Gerstein, Y. Wang [et al.] // DiabetesCare. -1999. - Vol. 22. - P. 233-240.
    • Chiasson J. L. STOP-NIDDM Trial Research Group. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial / J. L. Chiasson, R. G. Josse, R. Gomis [et al.] // JAMA. - 2003. - Vol. 290. - P. 486-494.
    • Cox F.J. Heartrate-correctedQTinterval is an independentpredictor of all-cause and cardiovascularmortality in individuals with type2diabetes: the DiabetesHeart Study / F.J. Cox, A. Azeem, J. Yeboah [et al.] // Diabetes Care. – 2014.- May;37(5).-P.1454-1461.
    • Eschwege E. Coronary heart disease mortality in relation with diabetes, blood glucose and plasma insulin levels. The Paris Prospective Study, ten years later / E. Eschwege, J. L. Richard, N. Thibult [et al.] // HormMetabRresSuppl -1985- Vol.15.- P.41-46.
    • Egi M. Variability of blood glucose concentration and short-term mortality in critically ill patients / M. Egi, R. Bellomo, E. Stachowski [et al.] // Anesthesilogy. - 2006. - Vol. 105. - P. 244-252.
    • Giunti S. Increased QT Interval Dispersion Predicts 15-Year Cardiovascular Mortality in Type 2 Diabetic Subjects. The population-based CasaleMonferrato Study / S. Giunti, G. Gruden, P. Fornengo [et al.] // Diabetes Care. - March 2012. - Vol. 35, N 3. - P. 581-583.
    • Hanefeld M. Risk factors for myocardial infarction and dethin newldetected NIDDM; the Diabetes International Study, 11-year follow-up / M. Hanefeld, S. Fischer, U. Julius [et al.] // Diabetologia. - 1996. - Vol. 39, N 12. - P. 1577-1583.
    • Jouven X. Predicting sudden death in the population: the Paris Prospective Study I / X. Jouven, M. Desnos, C. Guerot [et al.] // Circulation.-1999.-Vol.99.-P.1978–1983.
    • Junttila M. J. Sudden cardiac death after myocardial infarction in patients with type 2 diabetes / M. J. Junttila, P. Barthel, R. J. Myerburg [et al.] // Heart Rhythm- 2010– N7.-P.1396–1403.
    • Kannel W. B. Sudden coronary death in women / W. B. Kannel, P. W. Wilson, R. B. D’Agostino [et al.] // AmHeart J -1998 -№136.-Р.205 – 212.
    • Кrinsley J.S. Glycemic variability: a strong in depen dent predictor of mortality incritically illpatients / J.S. Кrinsley // Crit. CareMed. - 2008. - Vol. 36. - P. 3008-3013.
    • Lars Ryden ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD / Lars Ryden, Peter J. Grant, Stefan D. Anker. [et al.] // European Heart Journal – 2013.-№34.-Р.3035–3087.
    • Maser R. E. The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: a meta-analysis / R. E. Maser, B. D. Mitchell, A. I. Vinik [et al.] // DiabetesCare.- 2003- N.26.-P.1895–1901.
    • MacDonald M. R. Impact of diabetes on outcomes in patients with low and preserved ejection fraction heart failure: an analysis of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme / M. R. MacDonald, M.C. Petrie, F. Varyani [et al.] // Eur Heart J.- 2008- N29.- P.1377 – 1385.
    • Nolan J. Prospective study of heart ratev ariability and mortality in chronicheartfailure: results of the United Kingdom Heart Failure Evaluationand Assessment of Risk Trial (UK-Heart) / J. Nolan, P.D. Batin, R. Andrews [etal.] // Circulation. – 1998. – Vol. 98. – P. 1510-1516.
    • Nilsson P. M. ACCORD and Risk-Factor Control in Type 2 Diabetes./ P. M. Nilsson // N Engl J Med.- 2010.- Vol.362.- P.1628-1630.
    • Okin P.M. Electrocardiographic repolarisation complexity and abnormality predict all-cause and cardiovascular mortality in diabetes: the strong heart study / P.M. Okin, R. B. Devereux, E.T. Lee [et al.] // Diabetes.-2004.-Vol. 53, N 2.-P. 434-440.
    • Patel A. ADVANCE Collaborative Group. Effects of fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial):a randomized controlled trial / A. Patel // Lancet.-2007-Vol.370.-P.829-840.
    • La Rovere. Baro reflex sensitivity and heart-rate variability inprediction of total cardiac mortality after myocardial infarction. ATRAMI [Autonomic Toneand Reflexes After Myocardial Infarction] Investigators / La Rovere, M. T. Bigger, F. I. Marcus [et al.] // Lancet. - 1998. -Vol. 351, N 9101. - P. 478-484.
    • Rutter M. K. Impact of glucose intolerance and insulin resistance on cardiac structure and function: sex-related differences in Framingham Heart Study / M.K. Rutter, H. Parise, E. J. Benjamin [et al.] // Circulation. - 2003. -Vol. 107. - P. 448-454.
    • Schwartz P.J. The role of the auto nomic nervoussys temin sudden coronary death / P.J. Schwartz //AnnNyAcadSci. -1982.- Vol.382.-P. 162–180.
    • Service F. J. The relation of glyca emiatotherisk of development and progression of retino pathy in the Diabetic Controland Complications Trial / Service F.J., P. C. O’Brien // Diabetologia. - 2001. - Vol. 44. - P. 1215-1220.
    • Stevens R. J. The UKPDS risk engine: a model for the risk of coronary heart disease in Type II diabetes (UKPDS 56) / R. J. Stevens, V. Kothari, A. I. Adler [et al.] // ClinSci (Lond).- 2001.-Vol.101- P.671–679.
    • Suarez G. A. Sudden cardiac death in diabetes mellitus: risk factors in the Rochester diabetic neuropathy study / G. A. Suarez, V. M. Clark, J. E. Norell [et al.] // J Neurol Neurosurg Psychiatry.- 2005.- N.76.-P.240–245.
    • Salvi V. Comparison of QTc interval in diabetics with and without neuropathy and healthy normal volunteers / V. Salvi, P. Hingorani, V. Mahajan [et al.] // Indian Heart J. - 2007. - Vol. 58. - P. 418-423.
    • Veglio M. QT interval, Cardiovascular risk factors and risk of death in diabetes / M. Veglio, A. Chinaglia, P. Cavallo-Perin // J. Endocrinol. Invest. - 2004. - Vol. 27, N 2. - P. 175-181.
    • Ziegler D. Prediction of mortality using measures of cardiac autonomic dysfunction in the diabetic and nondiabetic population: the MONICA/KORA Augsburg Cohort Study / D. Ziegler, C.P. Zentai, S. Perz [et al.] // Diabetes Care.-2008- N.31.P.556–561.
    Publication of the article «World of Medicine and Biology» №2(50) 2 part 2015 year, 206-211 pages, index UDK 616.379-008.64:616-036.886