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Hypoglycemia and Elevated Troponin in Patients With Diabetes and Coronary Artery Disease
Paulo C Rezende1, Brendan M Everett2, Maria Mori Brooks3
1Heart Institute, University of São Paulo, São Paulo, Brazil.
Insights
Diabetic medications can cause hypoglycemia, potentially leading to heart damage. This study found that hypoglycemia is linked to higher cardiac troponin T (hsTnT) levels, but this association may stem from more severe diabetes.
Area of Science:
- Cardiology
- Endocrinology
- Diabetology
Background:
- Diabetic medications are known to cause hypoglycemia.
- Hypoglycemia can potentially lead to myocardial damage.
Purpose of the Study:
- To determine if hypoglycemia is associated with elevated high-sensitivity cardiac troponin T (hsTnT) levels.
- To investigate the relationship between hypoglycemia severity/frequency and hsTnT levels in patients with type 2 diabetes and coronary artery disease.
Main Methods:
- Analysis of data from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial.
- Classification of hypoglycemia by maximum severity and frequency in 1,984 patients.
- Multivariable regression analysis of high-sensitivity cardiac troponin T (hsTnT) levels measured at baseline and 1 year.
Main Results:
- Hypoglycemia, particularly severe or weekly occurrences, was associated with significantly higher hsTnT levels.
- Severe hypoglycemia showed a trend towards higher hsTnT levels even after adjusting for diabetes-related factors.
- The association between hypoglycemia and hsTnT was attenuated after adjusting for diabetes severity and duration.
Conclusions:
- Hypoglycemia is associated with elevated hsTnT levels in patients with type 2 diabetes and coronary artery disease.
- The observed association may be confounded by the severity of diabetes rather than being a direct effect of hypoglycemia.
- Further research is needed to elucidate the direct impact of hypoglycemia on cardiac damage.
Background:
Diabetic medications can cause hypoglycemia, which may lead to myocardial damage.
Objectives:
This study sought to determine whether hypoglycemia is associated with higher levels of high-sensitivity cardiac troponin T (hsTnT).
Methods:
The BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial randomized patients with type 2 diabetes mellitus and stable coronary artery disease, and closely followed them for hypoglycemia over the first year. Hypoglycemia was classified by maximum severity and frequency. hsTnT was measured at baseline and 1 year, and analyzed using multivariable regression.
Results:
Of 1,984 patients, follow-up hypoglycemia was absent in 1,026 (52%) patients, mild in 875 (44%), and severe in 83 (4%), and occurred less than weekly in 561 (28%) and greater than or equal to weekly in 397 (20%). hsTnT levels were associated with hypoglycemia: a median of 11.4 ng/l (interquartile range [IQR]: 8.1 to 17.3 ng/l) for none, 12.5 ng/l (IQR: 8.3 to 19.3 ng/l) for mild, and 13.7 ng/l (IQR: 9.9 to 24.9 ng/l) for severe hypoglycemia (p = 0.0001); and 12.5 ng/l (IQR: 8.3 to 18.1 ng/l) for less than weekly and 13.0 ng/l (IQR: 8.8 to 21.1 ng/l) for greater than or equal to weekly hypoglycemia (p = 0.0013). Severe hypoglycemia was associated with 34% higher 1-year hsTnT levels (p < 0.0001) in unadjusted analysis, 17% higher (p = 0.006) after adjustment for baseline factors unrelated to diabetes, and 6% higher (p = 0.23) after further adjustment for the duration and severity of diabetes. Hypoglycemia greater than or equal to weekly was associated with 14% higher hsTnT (p = 0.0003) in unadjusted analysis, 12% higher (p = 0.0002) after adjustment for baseline factors unrelated to diabetes, and 4% higher (p = 0.16) after adjustment for diabetes related factors.
Conclusions:
Hypoglycemia was associated with elevated hsTnT levels, but this may be due to more severe diabetes in patients who developed hypoglycemia, rather than the direct result of hypoglycemia. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes [BARI2D]; NCT00006305).
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