Severe Hypoglycemia and Cardiovascular Risk

Severe hypoglycemia has been associated with a wide range of conditions, including respiratory, digestive, and skin diseases. The lack of specificity to cardiovascular disease suggests that poor or failing health may be the underlying cause of both hypoglycemia and other diseases. A history of severe hypoglycemia is associated with alterations in cardiac function and can predict impending cardiovascular risk in elderly patients, according to a study published in the journal Diabetes Care on December 21, 2020.

Although most episodes of severe hypoglycemia resolve without apparent permanent injury, there are anecdotal reports of acute coronary syndromes coinciding with hypoglycemia in people with type 2 diabetes. There is suggestive evidence that hypoglycemia is associated with a substantially increased risk of cardiovascular disease. However, the mechanisms underlying this association remain unclear, especially in older patients. Therefore, Dr. Justin B. Echouffo-Tcheugui and colleagues conducted a study to assess the association of severe hypoglycemia measured at baseline with cardiovascular disease (CVD) among community-dwelling older individuals with diabetes, a group particularly susceptible to hypoglycemia.

Researchers included 2,193 older adults with diabetes from the Atherosclerosis Risk in Communities (ARIC) study who attended visit 5 (2011–2013, baseline). They determined severe hypoglycemia at baseline using first position ICD-9 codes from hospitalizations, emergency department visits, and ambulance calls. They examined cross-sectional associations of severe hypoglycemia with echocardiographic indices of cardiac structure-function. They also evaluated the risks of an incident or recurrent CVD (coronary heart disease, stroke, or heart failure) and all-cause mortality prospectively, from baseline to December 31, 2018, using negative binomial and Cox regression models.

Key Findings of the Study

• Among 2,193 participants, researchers identified 79 participants with a history of severe hypoglycemia at baseline.
• They found that severe hypoglycemia was associated with a lower left ventricular (LV) ejection fraction (adjusted β-coefficient −3.66%), higher LV end-diastolic volume (14.80 mL), higher E-to-A ratio (0.11), and higher septal E/e′ (2.48).
• Using adjusted models, they found that severe hypoglycemia was associated with an incident or recurrent CVD (incidence rate ratio 2.19) and all-cause mortality (hazard ratio 1.71) among those without prevalent CVD.

The authors concluded, "Our findings suggest that a history of severe hypoglycemia is associated with alterations in cardiac function and is an important marker of future cardiovascular risk in older adults."

For further information: https://care.diabetesjournals.org/content/44/1/248