Abstract
More than 450 million people worldwide have diabetes mellitus (DM), a metabolic disorder characterized by an increase in blood glucose level (hyperglycemia) that arises from insufficient insulin secretion or resistance to insulin’s action. More than 70% of individuals with chronic DM will develop cardiovascular diseases (CVDs) including atherosclerosis and coronary artery diseases (CADs), hypertension, cardiac arrhythmias, cardiomyopathy (heart failure), stroke, and chronic kidney disease. A significant number of these individuals will also succumb to sudden cardiac death (SCD). SCD usually occurs in early morning from abnormal heart rhythms or arrhythmias and ventricular fibrillation. When the pumping action of the heart becomes erratic, a reduction in oxygenated blood to the brain leads to unconsciousness and brain damage. SCD is independent of age and sex and positively correlates with impairment in cardiac metabolism, muscle damage, fibrosis, apoptosis, hypertrophy, ischemia, and deranged cation signaling. This review centers on mechanisms by which intracellular cations (Na+, K+, and Ca2+) handling, inflammation, and oxidative and carbonyl stresses due to diabetes-induced hyperglycemia can lead to the deterioration of excitation/contraction coupling (ECC), impaired contractility, arrhythmias, and SCD in DM patients. It also discusses the beneficial effects of exercise training to attenuate the risk of SCD.
Highlights
Sudden cardiac death (SCD) remains a major global public health problem, especially in developed countries such as the United States of America (USA), United Kingdom (UK), Germany and other countries
Epidemiological data show that macro-vascular complications including coronary artery disease (CAD), peripheral vascular disease (PVD) and SCD are 2–4 times more common among diabetic patients when compared with nondiabetic people [9]
The results reveal impaired insulin signaling in the heart and this in turn promotes oxidative stress and mitochondrial uncoupling
Summary
Sudden cardiac death (SCD) remains a major global public health problem, especially in developed countries such as the United States of America (USA), United Kingdom (UK), Germany and other countries. SCD is characterized by unexpected loss of the Sudden Cardiac Death pumping action of the heart due to a disturbance in its electrical system that results in irregular and dangerously fast beating of the heart [1]. SCD represents a major challenge for the clinician especially in individuals without a previous history of cardiac diseases. Prediction of individuals at risk of SCD can be life-saving. Most individuals experiencing SCD may not be identified as being a high risk and as such, the patients do not have ready access to a defibrillator. There must be community-based public access to defibrillation programmes in order to save the lives of the potential victims. With SCD, some patients experience tachycardia, dizziness and fainting while in some cases there are no prior symptoms [4, 5]
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