Diabetes linked to doubled mortality rates in takotsubo syndrome

Adults with takotsubo syndrome and diabetes have mortality rates about twice as high as those with takotsubo syndrome alone, according to a recent study published in Diabetes Care.

This finding contradicts the belief that diabetes plays a role in preventing takotsubo syndrome. In fact, after long-term follow-up of patients in this study, researchers identified diabetes as an independent predictor of increased mortality in takotsubo patients.

Diabetes and ‘broken hearts’

Takotsubo syndrome—also called broken heart syndrome—often occurs at times of acute emotional stress, particularly in postmenopausal women. Symptoms mimic acute coronary syndrome, which can be easily misdiagnosed as a heart attack. The syndrome is accompanied by reversible left ventricular apical ballooning of no apparent cause.

For this study, researchers evaluated patient data on 826 adults with takotsubo syndrome (median age 72; 83% men) from the multicenter German Italian Stress Cardiomyopathy Registry. Of these patients, 174 had type 2 diabetes.

Results showed that patients with diabetes were older, more frequently male, and had a higher prevalence of hypertension and physical triggers compared with participants without diabetes. Those with diabetes were also more likely to have the typical apical ballooning, which resulted in a more severely impaired left ventricular ejection fraction, a higher rate of pulmonary edema, and a longer hospital stay.

Increased mortality

In the short term (28 days), all-cause mortality didn’t differ significantly between patients with diabetes (6.4%) and patients without diabetes (5.7%). But after 2.5 years of follow-up, patients with diabetes had a significantly higher mortality rate (31.4%) than those without diabetes (16.5%).

After researchers adjusted for other clinical risk factors, multivariate regression analysis showed that diabetes remained a significant independent predictor of increased mortality compared with no diabetes (hazard ratio 1.66).

“These findings refute a protective role of diabetes for the occurrence of takotsubo syndrome and underline the detrimental long-term effects of diabetes,” wrote authors led by Ingo Eitel, MD, University of Lübeck Heart Center and German Center for Cardiovascular Research, Lübeck, Germany.

“Therefore, diabetes might represent an additional parameter for optimized risk stratification after takotsubo syndrome,” they concluded.