To the Editor:
1.
Desai et al1 reported on their explorations whether obesity affects the in‐hospital outcomes of patients who have suffered takotsubo syndrome (TTS), employing 612 obese TTS (weighted N = 3034) and 5696 non‐obese TCM (weighted N = 28 186) patients in propensity‐score matched cohorts, from the National Inpatient Sample database from 2010 to 2014. Although there were no significant differences in all‐cause mortality, arrhythmias, length of hospital stay, and total hospital charges, between the two groups, cardiac complications, such as acute myocardial infarction, cardiac arrest, cardiogenic shock, congestive heart failure, use of mechanical hemodynamic support (Impella®), and respiratory failure, were significantly higher among obese patients with TTS, as compared to non‐obese patients with TTS.1
Of particular interest to me was the information from table 2 of the authors’ article,1 titled “Comparison of comorbidities in obese vs non‐obese takotsubo cardiomyopathy patients”, where the unmatched non‐obese patients with a mean age of 66.7 years, and obese patients with a mean age of 62.1 years, had a prevalence of diabetes mellitus (DM) with chronic complications of 1.9% and 4.5% correspondingly, while the prevalence of DM with chronic complications in the propensity matched cohorts of non‐obese patients and obese patient was 5.1% and 4.5%, correspondingly.1 There have been previous reports associating TTS with low prevalence of DM,2, 3 suggestive of a “protective effect” of DM in the emergence of TTS. This does not imply that patients with DM are completely immune to DM, but it suggests that the TTS‐triggering stress (either physical or emotional) has to be enormous, and the DM to be of shorter duration, and of lower severity, and non‐associated with DM complications (particularly diabetic neuropathy, or even more specifically autonomic nervous system neuropathy) for patients to suffer TTS.2, 3 A prevalence of DM with chronic complications of 1.9% in the non‐obese patients and 4.5% in obese patients of the present study for patients >60 years old,1 appears to be low for what is most probably expected in the general US population,2, 3 from which the National Inpatient Sample database from 2010 to 2014 derives. I would very much appreciate the response of the authors on the above.
Conflict of interest
The authors declare no potential conflicts of interest
REFERENCES
- 1. Desai R, Singh S, Baikpour M, et al. Does obesity affect the outcomes in takotsubo cardiomyopathy?: analysis of the Nationwide inpatient sample database 2010‐2014. Clin Cardiol. 2018. 10.1002/clc.22999 [Epub ahead of print]. [DOI] [PMC free article] [PubMed] [Google Scholar]
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