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Gowdar et al. Diabetes mellitus and takotsubo cardiomyopathy

In this partial retrospective and partial prospective study, prevalence of DM and hypertension was evaluated.
[5]
190 patients enrolled in the Takotsubo Italian Network The identification of the prevalence of DM was the
Registry were selected (mean age 66.0 ± 11.4 years). [22] primary purpose of this analysis, with the prevalence of
Out of these 190 patients, 175 were female (92%). As hypertension used as an index of representativeness
compared to the prevalence of hypertension, which of the TC patients to the general population. Five
was found to be 48.4%, the prevalence of diabetes sub-analysis were performed in this study. In the first
was found to be very low (5.7%). Thus, this study also analysis, which included all TC patients including
favors the notion of DM playing a protective role in TC. single case reports and small and large case series,
comprising 33,894 patients (mean age 67.3 years
Case control studies and 89% females), 57.4% had hypertension, while
In a case-control study utilizing the NIS 2008-2009, the prevalence of DM was only 16.8%. In the second
Falola et al. [23] identified 1,724 patients with TC analysis (included only data from single patient case
(average age 65.3 years) as cases. When cases reports or patient series with patient data reported
were compared with controls [patients admitted with individually), comprising 1,085 patients (mean age 61.7
ST-Elevation myocardial infarction (STEMI) for initial years and 86.3% females), 42.8% had hypertension and
care], it was seen that females comprised 90.2% of the only 10.2% had DM. In the third analysis, using patient
patients in the TC group vs. only 35.7% in the STEMI case series with patient data reported collectively and
(control) group. The prevalence of hypertension excluding individually reported patients and comprising
was noted to be 58.6% and 66% among the cases 32,809 patients (mean age 67.3 years, 89% females),
and control groups respectively. On the other hand, 57.9% had hypertension while the prevalence of DM
diabetes was considered as a protective factor for TC was 17%. In the fourth analysis (TC patients aged > 60
as the prevalence of diabetes in TC cases was quite years, from case reports and case series with patient
low (1.6%). DM prevalence was significantly lower data reported individually) of 687 patients (mean age
in TC patients when compared to those with STEMI 72.2 years and 89% females), 50.4% had hypertension
(odds ratio 0.3, P < 0.0001). [23] while the prevalence of DM was 11.9%. Finally, in
the fifth analysis (TC patients > 65 years from singe
In another case control study, a total of 505 TC patients patient case reports and case series in which data
were identified from the Swedish Angiography and on patients were reported individually), comprising
Angioplasty Registry between 2009 and 2013 using the 550 TC patients (mean age 74.6 years and 91.1%
Mayo Clinic criteria. [24] The TC patients were matched females), 52.2% had hypertension while only 12.5%
for age and gender with controls with and without CAD. had DM. All five analyses in this study thus consistently
All the patients presented with an acute event/chest indicated a high prevalence of hypertension (> 50%),
pain and underwent coronary angiography to identify similar to the global and US rates of hypertension
the underlying cause. Among the 505 patients with prevalence (prevalence of age adjusted hypertension
TC, 442 (87.5%) were women with a mean age of 67 was 65.4% for those > 60 years in the National Health
± 10 years. Only 33 patients with TC (6.5%) had DM and Nutrition Evaluation Survey or NHANES study and
as compared to 200 patients (19.8%) with CAD, which 60-65% globally). Given that hypertension prevalence
further supports that DM plays a protective role in TC. was used an index of representativeness of the TC
patients to the general population in this meta-analysis,
In another Polish case-control study, 101 patients it was assumed that the TC patient population was a
hospitalized with TC were studied. [25] The control group comparable representative of the general population.
consisted of 101 female patients diagnosed with anterior Conversely, in all 5 analyses, DM had a low prevalence,
myocardial infarction with STEMI. The mean age was with prevalence rates of 16.8%, 10.2%, 17%, 11.9%
67.6 ± 14.2 years in the TC group vs. 72.1 ± 13.1 years and 12.5%, respectively. These prevalence rates
in the control group. Females comprised 89.5% of the were significantly lower than prevalence rates of DM
TC group. Whereas the prevalence of hypertension in similar age matched populations. Furthermore, this
was comparable in both the groups (63.2% in the TC study was a global analysis, using TC patients from
group and 68.3% in the control group), DM prevalence the entire world literature of TC. Global estimates of
was significantly lower in those with TC (12.6% in the DM prevalence in the elderly is around 20%, and in
TC group and 29.7% in the control group). this study, was 11.9% and 12.5% in the individual
case analyses of patients over 60 and 65 years of
Meta-analysis age, respectively. Thus, the prevalence of DM in the

In a meta-analysis of 959 papers including 794 TC patients was approximately half the expected
single or multiple patient case reports and 165 case prevalence rate of DM. In addition, in an analysis of
series, comprising a total of 33,894 TC patients, the 14 case series, with each case series comprising over

132 Vessel Plus ¦ Volume 1 ¦ September 26, 2017