J Korean Diabetes.  2016 Mar;17(1):24-29. 10.4093/jkd.2016.17.1.24.

Mechanism of Hypoglycemia-Associated Cardiovascular Diseases

• Kang YM
• Lee WJ

• KMID: 2161127
• DOI: http://doi.org/10.4093/jkd.2016.17.1.24

Abstract

Cardiovascular disease (CVD) is the leading cause of death in patients with diabetes mellitus. However, the benefit of intensive glycemic control in reducing CVD is unclear. In large clinical trials, intensive glycemic control was associated with increased incidence of hypoglycemia and all-cause mortality. Although it is uncertain whether hypoglycemia is a direct cause of CVD, a marker of vulnerability, or both, numerous studies have reported that hypoglycemia is associated with increased cardiovascular events such as cardiac arrhythmia and ischemia. The potential mechanisms of hypoglycemia-associated CVD include sympathoadrenal activation, repolarization abnormality, cardiac autonomic neuropathy, increased thrombogenesis, inflammatory reaction, and endothelial dysfunction. In this article, we review the evidence of an association of hypoglycemia with CVD in patients with diabetes and discuss the possible mechanisms through which hypoglycemia might result in adverse cardiovascular outcomes.

Keyword

Cardiovascular diseases; Diabetes mellitus; Hypoglycemia; Mechanism

MeSH Terms

Arrhythmias, Cardiac
Cardiovascular Diseases*
Cause of Death
Diabetes Mellitus
Humans
Hypoglycemia
Incidence
Ischemia
Mortality

Figure

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  Fig. 1. Suggested Mechanisms of Hypoglycemia-induced Cardiovascular Diseases. Revised from the article of Moheet and Seaquist (Curr Atheroscler Rep 2013;15:351) [8] with original copyright holder's permission. QTc, corrected QT.

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  Fig. 2. An electrocardiogram from a subject at hypoglycemic state (B) shows prolonged QT interval and prominent T and U waves, compared with an electrocardiogram from a subject at euglycemia (A). Revised from the article of Marques et al. (Diabet Med 1997;14:648–54) [15] with original copyright holder's permission. QTc, corrected QT; HR, heart rate.

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