Diabetes and sudden cardiac death: higher risk, especially for younger adults
News - Cardiovascular health
A large Danish study highlights a pronounced risk increase among younger people with diabetes. Sudden cardiac death (SCD) remains rare in healthy young adults, but the new findings show a meaningful elevation in risk for those with diabetes.
The study also confirms that diabetes shortens life expectancy on average, with a portion of those lost years attributable to SCD.
Led by Dr. Tobias Skjelbred of Copenhagen University Hospital, Rigshospitalet, the research analyzed data from the entire Danish population in 2010. The team reviewed all 54,028 deaths that year, using death records, hospital discharge summaries, and autopsy reports to identify SCD cases, ultimately confirming 6,862 events. By linking SCD data with diabetes status (type 1, type 2, or neither), the researchers compared SCD rates across the three groups. They found SCD was 3.7 times more common in people with type 1 diabetes and 6.5 times more common in those with type 2 diabetes, relative to the general population. The age-stratified findings were most striking in younger adults: individuals under 50 with diabetes faced seven times higher SCD risk.
The study also quantified life expectancy losses: on average, people with type 1 diabetes lived 14.2 years shorter, and those with type 2 diabetes 7.9 years shorter. SCD accounted for 3.4 of the lost years in type 1 diabetes and 2.7 in type 2 diabetes.
Predicting and preventing SCD remains challenging, but the results underscore the importance of diabetes patients actively collaborating with clinicians to lower cardiovascular risk.
Dr. Skjelbred commented: “Diabetes increases the occurrence of sudden cardiac death across all ages, and it substantially reduces life expectancy in those with the condition. While SCD risk rises with age in everyone, the relative disparity is clearest when comparing younger people with diabetes to their non-diabetic peers. This is an observational study, so it shows an association rather than proving causation. SCD is difficult to foresee and prevent, but the findings reinforce the need for personalized cardiovascular risk reduction in diabetes care.”
He added that multiple mechanisms likely contribute, potentially varying by age. Diabetes raises the risk of ischaemic heart disease, a key mechanism, and diabetes-specific factors such as hypoglycemia and cardiac autonomic neuropathy may increase the likelihood of arrhythmias and SCD. A limitation is that the study focuses on 2010 data, before widespread use of newer glucose-lowering therapies (e.g., SGLT2 inhibitors, GLP-1 receptor agonists). Consequently, it cannot assess how these treatments have impacted SCD in more recent years.
For individuals at very high risk of SCD, implantable cardioverter-defibrillators (ICDs) are available. The next steps proposed include identifying diabetes subgroups that could benefit from preventive strategies and researching ways to reduce SCD risk in diabetes.
In an accompanying editorial, Dr. Hanno Tan of Amsterdam UMC, Netherlands, notes that despite advances, SCD remains a prevention and treatment challenge due to its unpredictable nature and high fatality. The editorial emphasizes that this study is the first to quantify both the life-years lost due to diabetes and the portion attributable to SCD, with a notable finding: diabetes-associated SCD risk is higher in younger individuals than in older ones. Examples include an incidence rate of 22.7 among type 1 diabetes patients aged 30–40, and 6.0 among type 2 diabetes patients aged 40–50. The editorial also mentions ongoing efforts to develop automatic detection systems for SCA, potentially via wearables, which may particularly benefit type 1 diabetes patients who experience more unwitnessed SCA events. These developments could enable targeted, personalized interventions to prevent SCA or improve its treatment.
Source: European Society of Cardiology
05-12-2025
