Diabetes Mellitus in Patients With Suspected Acute Coronary Syndrome Versus Takotsubo Syndrome

The report by Auzel et al, published online ahead of print on January 28, 2016, in the Journal, about the 90 (87 women) patients who had suffered Takotsubo syndrome (TTS), among 5,484 patients who had presented with suspected acute coronary syndrome (ACS), focusing on the subgroup with and without ventricular arrhythmias, is of interest because it reveals differences in risk factors between suspected ACS and TTS. Looking at Table 1 of the investigators’ contribution one could see that patients with TTS were older by a mean of ∼6.5 years, were mainly women (97% vs 30%), had lower prevalence of smoking (28% vs 38%), dyslipidemia (29% vs 46%), a family history of coronary artery disease (8% vs 18%), similar prevalence of hypertension (46% vs 47%), and lower prevalence of diabetes mellitus (DM; 9% vs 18%) than patients with suspected ACS. Thus, the patients in this consecutive series of TTS had 1/2 of the prevalence of DM of the entire cohort of patients evaluated for suspected ACS. This prevalence of DM is very low for a group of women with a mean age of ∼72 years, considering that the prevalence of DM in European general populations is reported to be almost 3 times as high, particularly in women. This finding in the present study, is in agreement with a recent report about the low prevalence of DM in patients with TTS, and it may have pathophysiological connotations. The proposed hypothesis is that DM with its associated diabetic peripheral neuropathy (including autonomic nervous system neuropathy) exerts a “bridling” influence on the cardiac intense stimulation of the heart during emotional or physical stress, which otherwise would reach thresholds leading to the transient cardiac injury characteristic of TTS. Accordingly, few patients with DM, particularly with long-standing disease and complicating diabetic neuropathy are expected to suffer TTS, and when they do, this happens with intense emotional or physical stresses. Because the previously mentioned conceptualization represents “work in progress,” this reader will be grateful to the investigators if they provide information about the 8 patients with DM and TTS, in reference to type of DM, duration of their illness, antidiabetic drugs used, and whether they had peripheral (including autonomic nervous system) diabetic neuropathy.

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Nov 26, 2016 | Posted by in CARDIOLOGY | Comments Off on Diabetes Mellitus in Patients With Suspected Acute Coronary Syndrome Versus Takotsubo Syndrome

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