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Serious hypoglycemia linked to coronary artery calcium progression
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In patients undergoing standard therapy for glycemic control, serious hypoglycemia was associated with increased progression of coronary artery calcium, according to study findings.
Researchers found no association between coronary artery calcium and hypoglycemia in patients prescribed intensive antidiabetes therapy.
Aramesh Saremi, MD, of the Phoenix VA Health Care System, and colleagues evaluated data from the Veterans Affairs Diabetes Trial (VADT) on 197 participants to determine whether glycemic control influenced the relationship between serious hypoglycemia and coronary artery calcium progression. Participants were assigned standard or intensive treatment for glycemic control.
Participants underwent two coronary artery calcium scans with an average follow-up of 4.6 years between the scans. Overall, 97 participants experienced one or more serious hypoglycemic episodes, and 74% were in the intensive treatment arm. Of participants who did not experience a serious hypoglycemic event (n = 100), 21% were in the intensive treatment arm.
Across treatment groups, serious hypoglycemia was not linked to coronary artery calcium progression; however, there was an interaction between serious hypoglycemia and treatment type (P < .01). The relationship remained after adjustment for significant differences between those with and without serious hypoglycemia. Participants in the standard treatment arm with serious hypoglycemia had greater coronary artery calcium progression compared with those without serious hypoglycemia (P = .02).
In both treatment groups, greater coronary artery calcium progression was found in participants with higher mean HbA1c (> 7.5%) who had experienced serious hypoglycemia (P = .04). Increasing HbA1c was associated with coronary artery calcium progression in participants with serious hypoglycemia (P < .01), but not in those without serious hypoglycemia. In the standard treatment group, coronary artery calcium progression increased with increasing numbers of serious hypoglycemic episodes (P for overall difference between groups = .04).
“This study shows that serious hypoglycemia is associated with increased progression of [coronary artery calcium] in patients undergoing standard therapy for glycemic control and in those with higher HbA1c (> 7.5%) during the VADT, despite a nearly threefold higher frequency of serious hypoglycemia with intensive therapy,” the researchers wrote. “The results may provide additional insights into long-term cardiovascular benefits of intensive glycemic control and support the importance of avoiding hypoglycemia, particularly in elderly patients with long-standing, poorly controlled type 2 diabetes.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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