medwireNews: Analysis of the population-based ARIC cohort supports an association between severe hypoglycemia and both cardiovascular disease (CVD) and mortality in patients with diabetes.
A total of 1134 of the ARIC participants had diabetes at the 1996–1998 study visit, when they were aged around 64 years, and 178 of these were hospitalized or visited the emergency department for severe hypoglycemia during follow-up through 2013.
The crude incidence of incident CVD was more than doubled in patients with severe hypoglycemia versus those without, at around 1.5 versus 4.5 per 100 person–years, and the difference was even larger for all-cause mortality, at around three versus 12 per 100 person–years. The 3-year cumulative all-cause mortality rate in patients with hypoglycemia was 30%.
After accounting for demographic factors, CVD risk factors, and other variables including diabetes duration, diabetes medications, and kidney function, the risk for incident CVD was increased 1.64-fold and that for all-cause mortality 1.70-fold in patients with versus without hypoglycemia.
Hypoglycemia was associated with a significantly increased risk for CVD and coronary heart disease, but not for stroke, although this may have been because of the small number of stroke events.
The risk for mortality from both CVD and non-CVD causes was elevated among hypoglycemic patients, and the association between hypoglycemia and all-cause mortality risk was consistent across subgroups of age, gender, race, diabetes duration, and the presence of CVD at baseline.
Presenting their findings at the American Heart Association’s Epidemiology and Prevention/Lifestyle 2017 Scientific Sessions in Portland, Oregon, USA, the research team described severe hypoglycemia as an “under-utilized cardiovascular risk marker” in diabetes patients.
In a press statement, senior study author Elizabeth Selvin (Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA) noted that the CV benefits of lowering blood glucose may not be apparent for decades.
Considering the risk associated with hypoglycemia, she suggested: “If the benefit is 10 or 20 years down the line and your patients are in their 70s, maybe we shouldn’t be putting them on anti-diabetes medications. It’s something to consider.”
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