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Hypoglycemia, diabetes, and cardiovascular events.

Desouza CV, Bolli GB, Fonseca V - Diabetes Care (2010)

View Article: PubMed Central - PubMed

Affiliation: University of Nebraska Medical Center, Omaha, Nebraska, USA. cdesouza@unmc.edu

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Diabetes is at epidemic proportions in the U.S. Patients with diabetes are at increased risk for micro- and macrovascular complications... The possibility of hypoglycemia as a risk factor for cardiovascular events is a topic of much debate... The link between glycemic control and microvascular complications has been firmly established... However, the association between glycemic control and macrovascular disease is mainly obtained from epidemiological studies, and intensive glucose control has often failed to reduce macrovascular events... The earliest study in 1932 reported chest pain consistent with myocardial ischemia in two of seven type 1 diabetic patients with known cardiovascular disease... However, other similar studies failed to confirm these findings... Two patients had irreversible hypoglycemic brain damage and died after artificial ventilation... Nineteen others were sleeping alone at the time of death, and 20 were found lying undisturbed... Recently, several large randomized trials evaluating the effects of glycemic control on cardiovascular events have published their results... The ACCORD trial randomized 10,251 participants with a history of cardiovascular events or significant cardiovascular risk to a strategy of intensive glycemic control or standard glycemic control... The DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) study found that insulin-glucose infusion followed by intensive subcutaneous insulin in diabetic patients with acute myocardial infarction improved long-term survival... Conversely, the DIGAMI 2 study did not confirm superiority of insulin versus conventional treatment, but reaffirmed the importance of good glycemic control in prevention of cardiovascular events... A study by Kosiborod et al., looking at 16,871 patients admitted with myocardial infarction, found that a J-shaped relationship existed between glucose and mortality... Incremental increases above 120 mg/dl and incremental declines below 70 mg/dl were found to be strongly associated with increased mortality.

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Mechanisms by which hypoglycemia may affect cardiovascular events. Hypoglycemic events may trigger inflammation by inducing the release of C-reactive protein (CRP), IL-6, and vascular endothelial growth factor (VEGF). Hypoglycemia also induces increased platelet and neutrophil activation. The sympathoadrenal response during hypoglycemia increases adrenaline secretion and may induce arrhythmias and increase cardiac workload. Underlying endothelial dysfunction leading to decreased vasodilation may also contribute to cardiovascular risk.
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Figure 1: Mechanisms by which hypoglycemia may affect cardiovascular events. Hypoglycemic events may trigger inflammation by inducing the release of C-reactive protein (CRP), IL-6, and vascular endothelial growth factor (VEGF). Hypoglycemia also induces increased platelet and neutrophil activation. The sympathoadrenal response during hypoglycemia increases adrenaline secretion and may induce arrhythmias and increase cardiac workload. Underlying endothelial dysfunction leading to decreased vasodilation may also contribute to cardiovascular risk.

Mentions: Hypoglycemia induces several counterregulatory responses. They include a decrease in pancreatic β-cell insulin secretion, an increase in pancreatic α-cell glucagon secretion, an increased sympathoadrenal response with acute plasma increase in adrenaline and norepinephrine (in addition to its elevated tissue turnover), as well as an increased secretion of ACTH/glucocorticoids. Besides these classical responses, there are several indirect changes induced by hypoglycemia that affect inflammatory cytokine secretion, endothelial function, coagulation, and fibrinolysis. All of these responses have potential adverse effects on cardiovascular morbidity and mortality and will be discussed in this section (Fig. 1).


Hypoglycemia, diabetes, and cardiovascular events.

Desouza CV, Bolli GB, Fonseca V - Diabetes Care (2010)

Mechanisms by which hypoglycemia may affect cardiovascular events. Hypoglycemic events may trigger inflammation by inducing the release of C-reactive protein (CRP), IL-6, and vascular endothelial growth factor (VEGF). Hypoglycemia also induces increased platelet and neutrophil activation. The sympathoadrenal response during hypoglycemia increases adrenaline secretion and may induce arrhythmias and increase cardiac workload. Underlying endothelial dysfunction leading to decreased vasodilation may also contribute to cardiovascular risk.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2875462&req=5

Figure 1: Mechanisms by which hypoglycemia may affect cardiovascular events. Hypoglycemic events may trigger inflammation by inducing the release of C-reactive protein (CRP), IL-6, and vascular endothelial growth factor (VEGF). Hypoglycemia also induces increased platelet and neutrophil activation. The sympathoadrenal response during hypoglycemia increases adrenaline secretion and may induce arrhythmias and increase cardiac workload. Underlying endothelial dysfunction leading to decreased vasodilation may also contribute to cardiovascular risk.
Mentions: Hypoglycemia induces several counterregulatory responses. They include a decrease in pancreatic β-cell insulin secretion, an increase in pancreatic α-cell glucagon secretion, an increased sympathoadrenal response with acute plasma increase in adrenaline and norepinephrine (in addition to its elevated tissue turnover), as well as an increased secretion of ACTH/glucocorticoids. Besides these classical responses, there are several indirect changes induced by hypoglycemia that affect inflammatory cytokine secretion, endothelial function, coagulation, and fibrinolysis. All of these responses have potential adverse effects on cardiovascular morbidity and mortality and will be discussed in this section (Fig. 1).

View Article: PubMed Central - PubMed

Affiliation: University of Nebraska Medical Center, Omaha, Nebraska, USA. cdesouza@unmc.edu

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Diabetes is at epidemic proportions in the U.S. Patients with diabetes are at increased risk for micro- and macrovascular complications... The possibility of hypoglycemia as a risk factor for cardiovascular events is a topic of much debate... The link between glycemic control and microvascular complications has been firmly established... However, the association between glycemic control and macrovascular disease is mainly obtained from epidemiological studies, and intensive glucose control has often failed to reduce macrovascular events... The earliest study in 1932 reported chest pain consistent with myocardial ischemia in two of seven type 1 diabetic patients with known cardiovascular disease... However, other similar studies failed to confirm these findings... Two patients had irreversible hypoglycemic brain damage and died after artificial ventilation... Nineteen others were sleeping alone at the time of death, and 20 were found lying undisturbed... Recently, several large randomized trials evaluating the effects of glycemic control on cardiovascular events have published their results... The ACCORD trial randomized 10,251 participants with a history of cardiovascular events or significant cardiovascular risk to a strategy of intensive glycemic control or standard glycemic control... The DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) study found that insulin-glucose infusion followed by intensive subcutaneous insulin in diabetic patients with acute myocardial infarction improved long-term survival... Conversely, the DIGAMI 2 study did not confirm superiority of insulin versus conventional treatment, but reaffirmed the importance of good glycemic control in prevention of cardiovascular events... A study by Kosiborod et al., looking at 16,871 patients admitted with myocardial infarction, found that a J-shaped relationship existed between glucose and mortality... Incremental increases above 120 mg/dl and incremental declines below 70 mg/dl were found to be strongly associated with increased mortality.

Show MeSH
Related in: MedlinePlus