Mechanism of Hypoglycemia-Associated Cardiovascular Diseases

Yu Mi Kang; Woo Je Lee

doi:10.4093/jkd.2016.17.1.24

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Kang and Lee: Mechanism of Hypoglycemia-Associated Cardiovascular Diseases

Focused Issue

J Korean Diabetes 2016;17(1):24-29.

Published online: 10 January 2016

DOI: https://doi.org/10.4093/jkd.2016.17.1.24

Mechanism of Hypoglycemia-Associated Cardiovascular Diseases

Yu Mi Kang, Woo Je Lee

Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Corresponding author: Woo Je Lee Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea, E-mail: lwjatlas@amc.seoul.kr

Revised 6 January 2016 Accepted 3 February 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Cardiovascular diseases, Diabetes mellitus, Hypoglycemia, Mechanism

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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.

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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