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Response to Comment on: Kromhout et al. n-3 Fatty Acids, Ventricular Arrhythmia–Related Events, and Fatal Myocardial Infarction in Postmyocardial Infarction Patients With Diabetes. Diabetes Care 2011;34:2515–2520

  1. Daan Kromhout, MPH, PHD1 and
  2. Menko-Jan de Boer, MD, PHD2
  1. From the 1Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands; and the
  2. 2Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
  1. Corresponding author: Daan Kromhout, daan.kromhout{at}wur.nl.
Diabetes Care 2012 Jun; 35(6): e46-e46. https://doi.org/10.2337/dc12-0299
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In the Alpha Omega Trial, we observed that an additional amount of n-3 fatty acids significantly reduced the number of ventricular arrhythmia–related events and fatal myocardial infarctions (MIs) in post-MI patients with diabetes (1). In their letter, Giordani et al. (2) suggest that an abnormal cardiac repolarization, due to an imbalance of the autonomic nervous system, could be the link between diabetes and cardiac arrhythmias. In fact, we already observed in 1996 in the population-based Zutphen Elderly Study, that corrected QT prolongation was associated with the insulin resistance syndrome, and we concluded that insulin resistance may affect cardiac repolarization (3).

However, since then many other metabolic variables have been suggested. Therefore, it seems highly speculative to ascribe a reduction of ventricular arrhythmia–related events and fatal MI in our study to a single mechanism. Moreover, many other metabolic changes have been suggested as an explanation for sudden death in diabetic patients (4). Patients with diabetes who also have had an MI are at high risk of ventricular arrhythmia–related events and sudden death. These risks seem to be related to a large extent to factors specific to this metabolic disease, and our study results suggest that an arrhythmogenic substrate may be part of this process, independent of progression of coronary artery disease. It seems likely that factors such as atherosclerotic heart disease, direct metabolic alterations, ion channel abnormalities, and autonomic dysfunction may all contribute to create the substrate for sudden cardiac death in the diabetic heart.

Our finding that an additional amount of dietary n-3 fatty acids has a protective effect against ventricular arrhythmia–related events and fatal MI in post-MI patients with diabetes may relate to several of the above-mentioned mechanisms. The effect on the autonomic nervous system, as reported by Giordani et al., is probably one of them.

Acknowledgments

D.K. received grants from the Netherlands Heart Foundation, the National Institutes of Health, and Unilever Research and Development. No other potential conflicts of interest relevant to this article were reported.

  • © 2012 by the American Diabetes Association.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

References

  1. ↵
    1. Kromhout D,
    2. Geleijnse JM,
    3. de Goede J,
    4. et al
    . n-3 fatty acids, ventricular arrhythmia-related events, and fatal myocardial infarction in postmyocardial infarction patients with diabetes. Diabetes Care 2011;34:2515–2520
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Giordani I,
    2. Picconi F,
    3. Malandrucco I,
    4. Frontoni S
    . Comment on: Kromhout et al. n-3 fatty acids, ventricular arrhythmia-related events, and fatal myocardial infarction in postmyocardial infarction patients with diabetes. Diabetes Care 2011;34:2515–2520 (Letter). Diabetes Care 2012;35:e45. DOI: 10.2337/dc12-0107
  3. ↵
    1. Dekker JM,
    2. Feskens EJM,
    3. Schouten EG,
    4. Klootwijk P,
    5. Pool J,
    6. Kromhout D
    . QTc duration is associated with levels of insulin and glucose intolerance: the Zutphen Elderly Study. Diabetes 1996;45:376–380
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Rydén L,
    2. Standl E,
    3. Bartnik M,
    4. et al
    .; Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) European Association for the Study of Diabetes (EASD). Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. Eur Heart J 2007;28:88–136
    OpenUrlFREE Full Text
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Diabetes Care: 35 (6)

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June 2012, 35(6)
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Response to Comment on: Kromhout et al. n-3 Fatty Acids, Ventricular Arrhythmia–Related Events, and Fatal Myocardial Infarction in Postmyocardial Infarction Patients With Diabetes. Diabetes Care 2011;34:2515–2520
Daan Kromhout, Menko-Jan de Boer
Diabetes Care Jun 2012, 35 (6) e46; DOI: 10.2337/dc12-0299

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Response to Comment on: Kromhout et al. n-3 Fatty Acids, Ventricular Arrhythmia–Related Events, and Fatal Myocardial Infarction in Postmyocardial Infarction Patients With Diabetes. Diabetes Care 2011;34:2515–2520
Daan Kromhout, Menko-Jan de Boer
Diabetes Care Jun 2012, 35 (6) e46; DOI: 10.2337/dc12-0299
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  • Comment on: Kromhout et al. n-3 Fatty Acids, Ventricular Arrhythmia–Related Events, and Fatal Myocardial Infarction in Postmyocardial Infarction Patients With Diabetes. Diabetes Care 2011;34:2515–2520
  • Comment on: Leeds et al. High Prevalence of Microvascular Complications in Adults With Type 1 Diabetes and Newly Diagnosed Celiac Disease. Diabetes Care 2011;34:2158–2163
  • Response to Comment on: Wheeler et al. Macronutrients, Food Groups, and Eating Patterns in the Management of Diabetes: A Systematic Review of the Literature, 2010. Diabetes Care 2012;35:434–445
Show more Diabetes Care Electronic Pages

Online Letters: Observations

  • Comment on: Kromhout et al. n-3 Fatty Acids, Ventricular Arrhythmia–Related Events, and Fatal Myocardial Infarction in Postmyocardial Infarction Patients With Diabetes. Diabetes Care 2011;34:2515–2520
  • Comment on: Leeds et al. High Prevalence of Microvascular Complications in Adults With Type 1 Diabetes and Newly Diagnosed Celiac Disease. Diabetes Care 2011;34:2158–2163
  • Response to Comment on: Wheeler et al. Macronutrients, Food Groups, and Eating Patterns in the Management of Diabetes: A Systematic Review of the Literature, 2010. Diabetes Care 2012;35:434–445
Show more Online Letters: Observations

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© 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.