Risk of hypoglycemia in cardiovascular disease
Risk of hypoglycemia in cardiovascular disease can be at various levels. Though good long term control of diabetes mellitus is beneficial in those with cardiovascular disease, episodes of hypoglycemia has been shown to be deleterious. It has been associated with elevated cardiac troponins, though it has been questioned whether it is due to hypoglycemia per se or the more severe diabetes mellitus in these patients .
Severe hypoglycemia leads to sympathetic overactivity resulting in tachycardia, increased peripheral resistance, increased systemic blood pressure and enhanced myocardial contractility. All these can worsen myocardial ischemia and injury (as documented by elevated troponin), more so in those with pre-existing coronary artery disease .
Acute hypoglycemia may lead to release of vasoactive substances leading to vascular injury . This may be mediated by the release of catecholamines and other neurohormonal peptides in severe hypoglycemia. Increased levels of biomarkers, cell adhesion molecules, enhanced blood viscosity and platelet aggregation may promote a thrombogenic milieu leading to myocardial infarction .
Severe hypoglycemia may be associated with severe hypertension, hypokalemia and prolongation of QT interval . This could lead on to life threatening ventricular arrhythmias.
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