OBJECTIVE There is suggestive evidence linking hypoglycemia with cardiovascular disease, but few data have been collected in a community-based setting. Information is lacking on individual cardiovascular outcomes and cause-specific mortality.

RESEARCH DESIGN AND METHODS We conducted a prospective cohort analysis of 1,209 participants with diagnosed diabetes from the Atherosclerosis Risk in Communities (ARIC) study (analytic baseline, 1996–1998). Severe hypoglycemic episodes were identified using first position ICD-9 codes from hospitalizations, emergency department visits, and ambulance calls through 2013. Cardiovascular events and deaths were captured through 2013. We used adjusted Cox regression models with hypoglycemia as a time-varying exposure.

RESULTS There were 195 participants with at least one severe hypoglycemic episode during a median fellow-up of 15.3 years. After severe hypoglycemia, the 3-year cumulative incidence of coronary heart disease was 10.8% and of mortality was 28.3%. After adjustment, severe hypoglycemia was associated with coronary heart disease (hazard ratio [HR] 2.02, 95% CI 1.27–3.20), all-cause mortality (HR 1.73, 95% CI 1.38–2.17), cardiovascular mortality (HR 1.64, 95% CI 1.15–2.34), and cancer mortality (HR 2.49, 95% CI 1.46–4.24). Hypoglycemia was not associated with stroke, heart failure, atrial fibrillation, or noncardiovascular and noncancer death. Results were robust within subgroups defined by age, sex, race, diabetes duration, and baseline cardiovascular risk.

CONCLUSIONS Severe hypoglycemia is clearly indicative of declining health and is a potent marker of high absolute risk of cardiovascular events and mortality.

目的有将低血糖与心血管疾病联系起来的暗示性证据，但在基于社区的环境中收集的数据很少。缺乏有关个体心血管结局和特定病因死亡率的信息。

研究设计与方法我们从“社区动脉粥样硬化风险”（ARIC）研究（分析基线，1996-1998年）中对1,209名诊断为糖尿病的参与者进行了前瞻性队列分析。在2013年之前使用住院，急诊就诊和救护车呼叫中的首位ICD-9代码识别出严重的降血糖事件。在2013年之前记录了心血管事件和死亡。我们使用经过调整的Cox回归模型以及低血糖作为随时间变化的暴露。

结果在平均中位值为15.3年的研究中，有195名参与者出现了至少一次严重的降血糖事件。严重低血糖症发生后，3年累积性冠心病发病率为10.8％，死亡率为28.3％。调整后，严重的低血糖与冠心病（危险比[HR] 2.02，95％CI 1.27–3.20），全因死亡率（HR 1.73，95％CI 1.38–2.17），心血管疾病死亡率（HR 1.64、95）相关％CI 1.15–2.34）和癌症死亡率（HR 2.49，95％CI 1.46–4.24）。低血糖与中风，心力衰竭，心房颤动或非心血管和非癌性死亡无关。在由年龄，性别，种族，糖尿病病程和基线心血管风险定义的亚组中，结果是有力的。

结论严重的低血糖症清楚地表明健康状况下降，并且是心血管事件和死亡的绝对风险较高的有效标志。