Sub-clinic atherosclerosis in patients with postprandial reactive hypoglycemia
Sub-clinic atherosclerosis in patients with postprandial reactive hypoglycemia
Aim: Hypoglycemia is associated with excessive cardiovascular mortality because of the pro-inflammatory and pro-atherothromboticpathway stimulation. Hypoglycemia is known to affect the development of sub-clinic atherosclerosis. This study aims to determinethe development of sub-clinic atherosclerosis in patients with postprandial reactive hypoglycemia by investigating thickness ofcarotid intima media and epicardial fat, and high-sensitivity C-reactive protein values and their relationships with each other.Material and Methods: 51 patients in total were included in the project, including 28 patients (37.50±10.82 years) who hadhypoglycemia symptoms and who had hypoglycemia during prolonged oral glucose tolerance test and 23 healthy adult volunteers(35.01±10.92 years) as a control group. Subjects underwent echocardiographic examination including EFT and IMT measurementusing transthoracic echocardiography.Results: Postprandial Reactive Hypoglycemia group were marked with higher high-sensitivity C-reactive protein levels (1.67±0.67vs. 1.20±0.52; p= 0.007), carotid intima media thickness (0.65±0.10 vs. 0.50±0.10; p
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- 1. Hipoglisemi .Endokrinoloji 2011 Edition, Çetinkalp Ş. Ege Üniversitesi Basımevi, İzmir. 2011;289-94.
- 2. CryerPE. Hypoglycemia . Williams Textbook of Endocrinology. 12 th edition, Editors, Melmed S, Polonsky KS,Larsen PR, Kronenberg HM, USA. Saunders Elseiver, 2011;1552-77.
- 3. Alvin CP. Hipoglisemi. Harrison’s Principles of Internal Medicine Endokrinoloji Bölümü. 16. Basım, Editors, Kasper DL, Fauci AS, Longo DL, Braunwald E, Hauser SL, Jameson JL. Türkçe çeviri: Bereket A. Nobel Tıp Kitabevi, İstanbul. 2009;355-63.
- 4. Masharani U, Gitelman SE. Hypoglycemic Disorders. Greenspan’s Basic & Clinical Endocrinology. 8 th edition. Editors, Gardner DG, Shoback D. McGraw – Hill, USA. 2007;748-69.
- 5. Ross R. Atherosclerosis-an inflammatory disease. N Engl J Med 1999;340:115–26.
- 6. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation 2002;105:1135–43.
- 7. Wright RJ, Frier BM. Vascular disease and diabetes: is hypoglycaemia an aggravating factor? Diabetes Metab Res Rev 2008;24:353-63.
- 8. Schwartz NS, Clutter WE, Shah SD, et al. Glycemic thresholds for activation of glucose counterregulatory systems are higher than the threshold for symptoms. J Clin Invest 1987;79:777-81.
- 9. Yu H, Rifai N. High-sensitivity C-reactive protein and atherosclerosis: from theory to therapy. Clin Biochem 2000;33:601–10.
- 10. Persson J, Formgren J, Israelsson B, et al. Ultrasounddetermined intima-media thickness and atherosclerosis. Direct and indirect validation. Arterioscler Thromb 1994;14:261–4.
- 11. Schejbal V. Epicardial fatty tissue of the right ventricle--morphology, morphometry and functional significance. Pneumologie 1989;43:490–9.
- 12. Verhagen SN, Visseren FL. Perivascular adipose tissue as a cause of atherosclerosis. Atherosclerosis 2011;214:3–10.
- 13. Bachar GN, Dicker D, Kornowski R, et al. Epicardial adipose tissue as a predictor of coronary artery disease in asymptomatic subjects. Am J Cardiol 2012;110:534–8.
- 14. Gullu H, Erdogan D, Caliskan M, et al. Interrelationship between noninvasive predictors of atherosclerosis: transthoracic coronary flow reserve, flow-mediated dilation, carotid intima-media thickness, aortic stiffness, aortic distensibility, elastic modulus, and brachial artery diameter. Echocardiography 2006;23:835-42.
- 15. Rana O, Byrne CD, Kerr D, et al. Acute hypoglycemia decreases myocardial blood flow reserve in patients with type 1 diabetes mellitus and in healthy humans. Circulation 2011;124:1548-56.
- 16. Wei M, Gibbons LW, Mitchell TL, et al. Low fasting plasma glucose level as a predictor of cardiovascular disease and all-cause mortality. Circulation 2000;101:2047-52.
- 17. Libby P, Maroko PR, Braunwald E. The effect of hypoglycemia on myocardial ischemic injury during acute experimental coronary artery occlusion. Circulation 1975;51:621–6.
- 18. Trovati M, Anfossi G, Cavalot F, et al. Studies on mechanisms involved in hypoglycemia-induced platelet activation. Diabetes 1986;35:818–25.
- 19. Yang SW, Park KH, Zhou YJ. The impact of hypoglycemia on the cardiovascular system: physiology and pathophysiology. Angiology 2016;67:802–9.
- 20. Desouza CV, Bolli GB, Fonseca V. Hypoglycemia, diabetes, and cardiovascular events. Diabetes Care 2010;33:1389–94.
- 21. Irace C, Cutruzzolà A, Carbotti DF, et al. Hypoglycemia does not affect the progression of preclinical atherosclerosis in subjects with type 2 diabetes. PLoS One. 2019;14:e0212871.
- 22. Steinberg BA, Zhao X, Heidenreich PA, et al. Get with the Guidelines Scientific Advisory Committee and Investigators. Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction: prevalence, therapies, and outcomes. Circulation 2012;126:65-75.
- 23. O’Brien MJ, Karam SL, Wallia A, et al. Association of second-line antidiabetic medications with cardiovascular events among insured adults with type 2 diabetes. JAMA Netw Open. 2018;1:e186125.
- 24. Davis SN, Duckworth W, Emanuele N, et al. Investigators of the Veterans Affairs Diabetes Trial.Effects of severe hypoglycemia on cardiovascular outcomes and death in the Veterans Affairs Diabetes Trial. Diabetes Care 2019;42:157–163.
- 25. Lacobellis G, Bianco AC. Epicardial adipose tissue: emerging physiological, pathophysiological and clinical features. Trends Endocrinol Metab 2011;22:450-7.
- 26. Oyama J, Murohara T, Kitakaze M, et al. PROLOGUE Study Investigators. The Effect of Sitagliptin on Carotid Artery Atherosclerosis in Type 2 Diabetes: The PROLOGUE Randomized Controlled Trial. PLoS Med. 2016;13:e1002051.
- 27. Allameh Z, Rouholamin S, Adibi A, et al. Does Carotid Intima-media Thickness have Relationship with Polycystic Ovary Syndrome? Int J Prev Med 2013;4:1266-70.
- 28. O’Leary DH, Polak JF, Kronmal RA, et al. Carotid artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. N Engl J Med 1999;340:14–22.
- 29. Giménez M, Gilabert R, Monteagudo J, et al. Repeated episodes of hypoglycemia as a potential aggravating factor for preclinical atherosclerosis in subjects with type 1 diabetes. Diabetes Care 2011;34:198-203.
- 30. Kilpatrick ES, Rigby AS, Atkin SL. Mean blood glucose compared with HbA1c in the prediction of cardiovascular disease in patients with type 1 diabetes. Diabetologia 2008;51:365–71.
- 31. Peña AS, Couper JJ, Harrington J, et al. Hypoglycemia, but not glucose variability, relates to vascular function in children with type 1 diabetes. Diabetes Technol Ther 2012;14:457–62.
- 32. Mita T, Katakami N, Shiraiwa T, et al. Relationship between frequency of hypoglycemic episodes and change in carotid atherosclerosis in insulin-treated patients with type e diabetes mellitus. Scientific Report 2017;7:39965
- 33. Castaldo E, Sabato D, Lauro D, et al. Hypoglycemia assessed by continuous glucose monitoring is associated with preclinical atherosclerosis in individuals with impaired glucose tolerance. PLoS One 2011;6:e28312.