Title:Hypoglycaemia and Cardiovascular Disease Risk in Patients with Diabetes
Volume: 26
Issue: 43
Author(s): Niki Katsiki*, Kalliopi Kotsa, Anca P. Stoian and Dimitri P. Mikhailidis
Affiliation:
- Division of Endocrinology and Metabolism, Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki,Greece
Keywords:
Hypoglycaemia, cardiovascular risk, coronary heart disease, stroke, peripheral artery disease, dementia, carotid disease, cardiac
arrhythmias, mortality.
Abstract: Hypoglycaemia represents an important side effect of insulin therapy and insulin secretagogues. It
can occur in both type 1 and type 2 diabetes mellitus patients. Also, some associations between hypoglycaemia
and cardiovascular (CV) risk have been reported. Several mechanisms may be involved, including the sympathoadrenal
system, hypokalaemia, endothelial dysfunction, coagulation, platelets, inflammation, atherothrombosis
and impaired autonomic cardiac reflexes. This narrative review discusses the associations of hypoglycaemia
with CV diseases, including coronary heart disease (CHD), cardiac arrhythmias, stroke, carotid disease and peripheral
artery disease (PAD), as well as with dementia. Severe hypoglycaemia has been related to CHD, CV
and all-cause mortality. Furthermore, there is evidence supporting an association between hypoglycaemia and
cardiac arrhythmias, potentially predisposing to sudden death. The data linking hypoglycaemia with stroke,
carotid disease and PAD is limited. Several factors may affect the hypoglycaemia-CV relationships, such as the
definition of hypoglycaemia, patient characteristics, co-morbidities (including chronic kidney disease) and antidiabetic
drug therapy. However, the association between hypoglycaemia and dementia is bilateral. Both the disorders
are more common in the elderly; thus, glycaemic goals should be carefully selected in older patients. Further
research is needed to elucidate the impact of hypoglycaemia on CV disease.
