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Prior hypoglycemia increases CAD risk in patients with high vascular risk
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A relationship was found between prior hypoglycemia and coronary artery disease among patients at high vascular risk.
However, in the majority of primary care patients with lower underlying vascular risk, hypoglycemia may not be a risk factor for CAD, according to the researchers.
James B. Meigs , MD, MPH, of Massachusetts General Hospital in Boston, and colleagues evaluated 9,173 hospital patients with diabetes without CAD before Jan. 1, 2006 to determine if a relationship exists between prior hypoglycemia and incident CAD and if the risk varied in patients with different underlying vascular risk. Participants were followed until June 30, 2012 or incident CAD.
The link between hypoglycemia and CAD was tested among high vascular risk patients (aged 55 years; HbA1c 7.5%; 2 factors), a subset of high vascular risk patients aged 65 years or older and the remaining patients with lower vascular risk.
At baseline, 3% of participants had hypoglycemia and 12% developed CAD during follow-up; among participants who did not develop CAD, 14.6% died and 14.7% left the network. More participants with hypoglycemia died (23.2%) compared with those without hypoglycemia (14.4%).
A nearly twofold increase in incident CAD risk was found with hypoglycemia (HR = 1.96; 95% CI, 1.09-3.31); the association remained following adjustment for socio-demographic characteristics, hypertension, dyslipidemia, diabetes duration, BMI and HbA1c (HR = 2.15; 95% CI, 1.24-3.74).
CAD development was more common in patients at high vascular risk (16.8%) compared with those with low vascular risk (10.8%). Hypogylcemia was associated with a threefold risk for incident CAD among the high vascular risk group (HR = 3.01; 95% CI, 1.15-7.91) and a fourfold risk among the participants aged 65 years and older (HR = 1.62; 95% CI, 1.65-12.9). No link between hypoglycemia and incident CAD was found among the low risk group.
“Findings from our investigation support practice guidelines that recommend avoiding hypoglycemia in older diabetes patients with multiple comorbidities,” the researchers wrote. “This could be achieved through systematically assessing hypoglycemia risk, minimizing medication complexity and overtreatment, focusing on diabetes education, and adopting treatment goals that prioritize safety.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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