title: Hypoglycemia and Cardiovascular Disease: Lessons from Outcome Studies.
abstract: Severe hypoglycemia is recognized to be one of the strongest predictors of macrovascular events, adverse clinical outcomes, and mortality in patients with type 2 diabetes. Large clinical trials have reported an increased hazard ratio for all-cause mortality and cardiovascular events in patients with type 2 diabetes and severe hypoglycemia. However, these trials also reported an increased hypoglycemia-associated mortality rate in patients allocated to standard treatment by a factor of 1.5-2 despite a significant 50 % to 70 % lower incidence of hypoglycemia compared to the intensive treatment group. Although the potential for a causal relationship has been demonstrated in mechanistic studies, the evidence from large prospective studies suggest that other pre-existing cardiovascular risk factors in addition to hypoglycemia may be the major link to the final cardiovascular event, and that a low blood glucose level can trigger these events in patients with a high cardiovascular risk.
authors.affiliation: Study Center Professor Hanefeld, GWT TU-Dresden GmbH, Fiedlerstrasse 34, 01307, Dresden, Germany. frank.pistrosch@uniklinikum-dresden.de.|Medical Clinic III, Universitätsklinikum "Carl Gustav Carus", Dresden, Germany. frank.pistrosch@uniklinikum-dresden.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Pistrosch
authors.affiliation: Study Center Professor Hanefeld, GWT TU-Dresden GmbH, Fiedlerstrasse 34, 01307, Dresden, Germany.|Medical Clinic III, Universitätsklinikum "Carl Gustav Carus", Dresden, Germany.
authors.forename: Markolf
authors.initials: M
authors.lastname: Hanefeld
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D006801:Humans; D007003:Hypoglycemia / Q000150:complications*; D015994:Incidence; D017063:Outcome Assessment, Health Care; D012307:Risk Factors
keywords: Cardiovascular risk; Diabetes; Hypoglycemia; Outcome trials