# Clinical and pathophysiological links between hypoglycemia and cardiovascular risk in type 2 diabetes mellitus

## TL;DR

Severe low blood sugar in type 2 diabetes is linked to higher heart disease risk due to stress on the body and blood vessels.

## Contribution

This paper reviews clinical and biological connections between severe hypoglycemia and cardiovascular risk in diabetes.

## Key findings

- Severe hypoglycemia is associated with increased coronary heart disease and cardiovascular events in diabetes patients.
- Hypoglycemia triggers inflammation, blood clotting, and heart stress, worsening cardiovascular outcomes.
- Recurrent hypoglycemia may lead to microvascular dysfunction and adverse heart remodeling in diabetes.

## Abstract

Severe hypoglycemia increases the risk of cardiovascular disease (CVD) in people with diabetes. Large cohort studies and scientific statements show that severe hypoglycemia is linked to higher rates of coronary heart disease, cardiovascular events, and mortality in both type 1 and type 2 diabetes. This risk is especially high in individuals with significant vascular risk, such as older adults and those with multiple cardiovascular risk factors. Hypoglycemia triggers several pathophysiological changes that increase cardiovascular risk. These include activation of the sympathoadrenal system, promotion of proinflammatory and prothrombotic states, arrhythmogenic changes, and increased hemodynamic stress. Experimental evidence shows that recurrent hypoglycemia worsens microvascular dysfunction and promotes adverse cardiac remodeling, especially in people with diabetes. While the link between hypoglycemia and cardiovascular events is well established, the causality remains debated. Hypoglycemia may directly contribute to cardiovascular disease or indicate underlying vulnerability, especially in patients with advanced disease or comorbidities. Minimizing hypoglycemic episodes is recommended for all patients with diabetes, particularly those with established cardiovascular disease, due to the clear association with adverse outcomes.