Sharma A, et al. - The specific causes of death and their associated risk factors were evaluated in a contemporary cohort of patients with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD). The most common subcategory of cardiovascular (CV) death was sudden death. To reduce the risk of specific CV death subcategories, heart failure (HF) prevention could represent an avenue.

• Data was used from the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) study (n = 14,671), a cardiovascular (CV) safety trial adding sitagliptin vs. placebo to usual care in patients with type 2 diabetes and ASCVD (median follow-up 3 years).
• For this study, an independent committee blinded to treatment assignment adjudicated each cause of death.
• The authors used Cox proportional hazards models to identify risk factors associated with each outcome.

• The authors adjudicated 1,084 deaths as the following: 530 CV (1.2/100 patient-years [PY], 49% of deaths), 338 non-CV (0.77/100 PY, 31% of deaths), and 216 unknown (0.49/100 PY, 20% of deaths).
• Sudden death (n = 145, 27% of CV death) was the most common CV death followed by acute myocardial infarction (MI)/stroke (n = 113 [MI n = 48, stroke n = 65], 21% of CV death) and heart failure (HF) (n = 63, 12% of CV death).
• Malignancy (n = 154, 46% of non-CV death) was the most common non-CV death.
• Among patients with no baseline history of HF, the risk of specific CV death subcategories including sudden death (hazard ratio [HR] 0.4; P = 0.0036), MI/stroke death (HR 0.47; P = 0.049), and HF death (HR 0.29; P = 0.0057) was lower.