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Gowdar et al. Diabetes mellitus and takotsubo cardiomyopathy

development of TC. increased nearly 3-fold, from 1,642 cases in 2007 to
5,480 cases in 2012. The mean age of patients with
In this retrospective study based on the National TC was 65.7 years and more than 9 out of 10 (92.0%)
Inpatient Samples (NIS) Database 2008 to 2009, a were women. Whereas hypertension was present in
total of 24,701 patients with takotsubo cardiomyopathy 64.2% patients (ranging 59.2-67.6%), uncomplicated
were identified (mean age was 66.9 ± 30.7 years DM was seen in only 18% of the patients (ranging
with patients aged > 64 years comprising 59.6% 15.6-19.3%). On the other hand, complicated DM
of the group). [12] Among the patients with TC, 89% was found to be present in even a lower percentage
were females and 11% males. Although the primary of TC patients (only 2.6%, ranging 1.4-3.2%). This
outcome of the study was in-patient mortality but other study strongly supports the role of diabetic autonomic
associated chronic comorbidities were also reported. neuropathy/end-organ damage protecting the heart
The prevalence of hypertension and hyperlipidemia from catecholamine damage in TC.
was found to be 58.4% and 37.5% respectively. And
the prevalence of diabetes mellitus was 18.9%, which Prospective studies
was lower than the prevalence of diabetes in the In a multi-center study conducted prospectively in
general population group aged ≥ 65 years (25.9% in Europe and North America between January 2005
general population aged > 65 years, National Diabetes and October 2010, 256 patients with TC were included
Statistics Report 2014). and assessed at initial presentation as well as 1-6
months after the acute event (mean age 69 years and
In a retrospective study and analysis of the electronic 89% females). [17] Whereas hypertension was noted in
medical records of patients diagnosed with apical 73% of the patients, DM was noted in only 19% of the
ballooning syndrome or stress cardiomyopathy at Mayo patients. This data also depicts a low prevalence of DM
Clinic, a total of 224 patients were included (94.6% in TC.
were females and mean age 71.7 ± 10.4 years). [13]
Hypertension was present in 70.9% of the patients Another prospective study comprising 100 patients
while diabetes was present in only a small percentage (between 2002-2010) was conducted to determine
of the patients (13.8%). Again, this study supports the the incidence of TC and associated risk factors for the
protective role of diabetes in TC. development of heart failure in TC. [18] The mean age
was 68 years and 89% were post-menopausal women.
In a different retrospective descriptive study reviewing While hypertension was present in 68% of the patients
patients with the discharge diagnosis of TC between with TC, DM was present in only 18% of the patients.
2003 and 2014 at Einstein Medical Center in As seen in other studies, this study also suggests a
Philadelphia, a total of 206 TC patients were identified. [14] protective role of DM in TC.
Overall mean age was 67.8 years. Out of the 206
patients, 179 (87%) were females and 41 (19%) had Registries
diabetes. As compared to the low prevalence of diabetes In a large multicenter prospective registry (RETAKO
in these patients, the prevalence of hypertension was registry, Spain), 202 patients with TC were studied
seen to be much higher (68.4%). (90% females, mean age 70 years). [19] The incidence
of DM was 15% while the prevalence of other standard
In a retrospective study of 5,484 patients referred to the cardiac risk factors including hypertension and
coronary care unit for acute coronary syndrome (ACS) dyslipidemia were 69% and 41% respectively. This
between 2001 and 2013, the clinical records were study again suggested a relative low prevalence of DM
studied and reviewed. [15] Out of this, 90 patients were in TC.
found to have TC. The mean age of patients with TC
was 71.9 ± 12.7 years and 97% were females. While A more recent study utilizing the data from the
the prevalence of hypertension was comparable in International Takotsubo registry compared 455 patients
both groups (46% and 47% in TC and ACS group), DM with TC to age and gender matched patients with ACS
was present in only 9% of TC patients as compared to (mean age 67.7 ± 12.5 years and 68.7 ± 12.3 years,
17% of patients with ACS. A lower prevalence of DM in respectively and 90.3% women in both cohorts). [20] DM
TC again signifies its protective effect in the disease. prevalence was 12.8% in the TC group, and 26.6%
in the ACS cohort. Prevalence of hypertension was
In another study utilizing the NIS Database data 2007 comparable among both the cohorts (about 65% in
to 2012, Khera et al. [16] identified 22,005 patients who each cohort). [20,21] Thus, this study further strengthens
were discharged with a primary diagnosis of TC in the the hypothesis of DM being possibly protective against
US. The number of hospitalizations was seen to have the development of TC.
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