Abstract 43: Association of Severe Hypoglycemia With Cardiovascular Disease and All-cause Mortality in Older Adults With Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study
Introduction: There is concern that the strong association of severe hypoglycemia with cardiovascular disease (CVD) and all-cause mortality is confounded by diabetes severity or may not be causal and simply reflects general vulnerability. Our objective was to determine if the association of hypoglycemia with CVD and death withstood rigorous adjustment for likely confounders that prior studies have not adequately accounted for.
Methods: We included ARIC participants aged 65+ at Visit 4 (1996-1998) with diagnosed diabetes and CMS Part B insurance. Severe hypoglycemia was identified through 2013 with ICD-9 codes from hospitalizations, emergency department visits, and ambulance services. CVD events (coronary heart disease, stroke, or heart failure) and death were assessed through 2013. Hypoglycemia was a time-varying exposure in progressively adjusted Cox models that included demographics, clinical characteristics, comorbidities, cognitive function, and activities of daily living and instrumental activities of daily living.
Results: Of the 464 eligible participants, hypoglycemic events occurred in 65 participants prior to CVD or censoring and in 94 participants prior to death or censoring. The crude incidence rates of CVD and death were higher in persons with hypoglycemia compared to those without (CVD: 10.6 vs. 5.08 per 100 person-years (PY), p<0.001; death: 14.3 vs. 4.5 per 100 PY, p<0.001). After adjustment for age, sex, and race-center, hypoglycemia was strongly associated with both CVD and death (Figure). After additional adjustment for confounders, the hazard ratios (HR) for hypoglycemia were substantially attenuated but remained significant (CVD HR: 1.61 (95%CI 1.06-2.46); death HR: 1.83 (95%CI 1.35-2.84)).
Conclusion: After adjustment for rigorously measured shared risk factors, hypoglycemia was associated with both CVD and death. These results suggest that severe hypoglycemia may influence CVD risk and death independently of diabetes severity and general vulnerability.
Author Disclosures: A.K. Lee: None. B. Warren: None. C.J. Lee: None. E.S. Huang: None. A. Sharrett: None. J. Coresh: None. E. Selvin: None.
- © 2017 by American Heart Association, Inc.