TOPLINE

Diabetes was associated with sudden cardiac death (SCD) regardless of the presence of obstructive coronary artery disease (CAD), and among patients with both diabetes and CAD, revascularisation was linked to a lower risk for SCD. Although diabetes conferred similar risks for sudden and non‑sudden death, the majority of deaths were due to non-sudden cardiac arrest (SCA).

METHODOLOGY

• Researchers conducted a retrospective cohort study to evaluate whether diabetes is associated with SCD independent of CAD status, while accounting for competing non-sudden mortality, and to assess whether revascularisation strategy potentially affects the risk for SCD in patients with diabetes and CAD.
• They analysed 22,395 consecutive patients who underwent coronary angiography at a hospital in Finland from 2007 to 2018; of these, 5804 patients (mean age, 68.3 years; 65.4% men) had diabetes and 16,591 (mean age, 66.9 years; 62.7% men) had no diabetes.
• The primary outcome was SCD or an equivalent event, adjudicated from medical records, death certificates, and nationwide mortality data; a broader endpoint of SCA was also examined.
• The median follow-up duration was 8.1 years after the index angiography.

TAKEAWAY

• During follow-up, 1046 patients had SCD or an equivalent event, and 1710 patients met the broader SCA endpoint; after adjustment, diabetes was linked to a higher risk for SCD (subdistribution hazard ratio [SHR], 1.38) and showed a similar association with non‑SCD (SHR, 1.37; P < .001 for both).
• Non‑SCA death far outnumbered SCA events: The 10‑year cumulative incidence in patients with diabetes was 35.9% for non-SCA death vs 11.3% for SCA, and in those without diabetes, it was 25.1% vs 6.3%.
• In patients with diabetes and CAD, coronary revascularisation was associated with a lower risk for SCD or an equivalent event than medical therapy alone (SHR, 0.77; P = .039). Diabetes remained associated with SCD even when angiography showed no obstructive CAD (SHR, 1.53; P = .010).
• The association between diabetes and SCD or an equivalent event appeared stronger in patients younger than 70 years, those with left ventricular ejection fraction of 40% or above, and those with type 1 diabetes, and higher A1c levels were linked to a greater risk for fatal SCD.

IN PRACTICE

"Our findings underscore the need for improved SCD risk stratification among individuals with diabetes and highlight age, left ventricular function, diabetes type, glycemic control, and potential sex differences as characteristics that may distinguish higher-risk subgroups within the diabetic population," the authors wrote.

SOURCE

The study was led by Jani Rankinen, MD, PhD, Tampere University, Tampere, Finland. It was published online on August 18, 2026, in Cardiovascular Diabetology.

LIMITATIONS

The study was conducted in Finland in a mostly Caucasian population within a centralised healthcare system. Reliable data on diabetes duration and new diabetes diagnoses during follow‑up were not available, and the study could not assess how newer glucose‑lowering drugs such as SGLT2 inhibitors might have changed outcomes. Moreover, the analysis was retrospective and non-randomised.

DISCLOSURES

The study was supported by multiple sources, including Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital, Tampere University Hospital support association, and Finnish Foundation for Cardiovascular Research. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.