title: Hypoglycemia and Cardiovascular Risk: Is There a Major Link?
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. However, it is uncertain whether a direct pathophysiological link exists or whether hypoglycemia is primarily a marker of vulnerability to these events. 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, but such an association has not been demonstrated in prospective trials of people with type 1 diabetes. Several cardiovascular effects occur during hypoglycemia either as a result of low blood glucose levels per se or through activation of the sympathoadrenal response: hemodynamic changes with an increase in cardiac work load and potential attenuation of myocardial perfusion, electrophysiological changes that may be arrhythmogenic, induction of a prothrombotic state, and release of inflammatory markers. Although the potential for a causal relationship has been demonstrated in mechanistic studies, the evidence from large prospective studies that hypoglycemia is a major causal contributor to cardiovascular events is limited to date. Other preexisting cardiovascular risk factors in addition to hypoglycemia may be the major link to the final cardiovascular event, but a low blood glucose level can trigger these events in patients with a high cardiovascular risk.
authors.affiliation: Study Centre Professor Hanefeld, GWT-TU Dresden GmbH, Dresden, Germany Medical Clinic III, Universitätsklinikum "Carl Gustav Carus," Dresden, Germany hanefeld@gwtonline-zks.de.
authors.forename: Markolf
authors.initials: M
authors.lastname: Hanefeld
authors.affiliation: British Heart Foundation Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, U.K.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Frier
authors.affiliation: Study Centre Professor Hanefeld, GWT-TU Dresden GmbH, Dresden, Germany Medical Clinic III, Universitätsklinikum "Carl Gustav Carus," Dresden, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Pistrosch
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D007004:Hypoglycemic Agents