Supplementary DataNew-DC20-0552-Revision2.pdf (296.82 kB)

Severe Hypoglycemia, Cardiac Structure and Function, and Risk of Cardiovascular Events among Older Adults with Diabetes

Download (296.82 kB)
figure
posted on 16.11.2020, 18:44 by Justin B. Echouffo-Tcheugui, Natalie Daya, Alexandra K Lee, Olive Tang, Chiadi E. Ndumele, B. Gwen Windham, Amil M. Shah, Elizabeth Selvin
Objective: To assess the association of severe hypoglycemia measured at baseline with cardiovascular disease (CVD) among community-dwelling older individuals with diabetes, a group particularly susceptible to hypoglycemia.

Methods: We included older adults with diabetes from the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 5 (2011–2013, baseline). Severe hypoglycemia at baseline was defined using first position ICD-9 codes, from hospitalizations, emergency department visits, and ambulance calls. We examined cross-sectional associations of severe hypoglycemia with echocardiographic indices of cardiac structure-function. We prospectively evaluated the risks of incident or recurrent CVD (coronary heart disease, stroke or heart failure) and all-cause mortality, from baseline to 31 December 2018, using negative binomial and Cox regression models.

Results: Among 2,193 participants (mean age: 76 years [SD: 5], 57% female, 32% blacks), 79 had a history of severe hypoglycemia at baseline. Severe hypoglycemia was associated with a lower left ventricular (LV) ejection fraction (adjusted beta coefficient: -3.7 % [95% CI: -5.5, -1.7]), higher LV end diastolic volume (14.8 ml [95% CI: 8.8, 20.8]), higher E/A ratio (0.11 [95% CI: 0.03, 0.18]), and higher septal E/e’ (2.48 [95%CI: 1.13, 3.82]). In adjusted models, severe hypoglycemia was associated with incident or recurrent CVD (incidence rate ratio [IRR]: 2.49 (95% CI 1.4, 4.39]) and all-cause mortality (HR 1.70 [95% CI 1.10, 2.67]) among those without prevalent CVD.

Conclusions: Our findings suggest that a history severe hypoglycemia is associated with alterations in cardiac function and is an important marker of future cardiovascular risk in older adults.

Funding

The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I). The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr Echouffo Tcheugui was supported by NIH/NHLBI grant K23 HL153774. Dr. Selvin was supported by NIH/NHLBI grant K24 HL152440 and NIH/NIDDL grant R01DK089174. Dr Shah was supported by NIH/NHLBI grants R01HL135008 and R01HL143224. Dr Lee was supported by NIH/NIA grant T32AG000212. Dr. Tang was supported by F30DK120160.

History

Exports