Asymptomatic Reactive Hypoglycemia and Inflammatory Reaction in Patients with Coronary Artery Disease

Abstract

SummaryHyperglycemia is an established risk factor of coronary artery disease (CAD). However, hyperglycemia with preserved pancreatic β cell function induces hyperinsulinemia to correct the glucose profile and may even result in reactive hypoglycemia (RH), which induces an inflammatory response. In this study, the incidence of RH and its effect on arteriosclerosis were examined in CAD patients with a lengthy oral glucose tolerance test (OGTT).We performed a prospective cross-sectional study on 116 nondiabetic CAD patients [70 ± 9 years, 70% male, HbA1c < 6.5%] using coronary angiography and a 4-hour OGTT. Blood samples were collected prior to and 4 hours after the glucose load to evaluate arteriosclerosis markers. Hypoglycemia following the glucose tolerance test was defined as blood glucose levels < 70 mg/dL. We comparatively examined markers of inflammation and arteriosclerosis between the RH group and the non-RH group.A glucose metabolism disorder was observed in 69% of the patients. Hypoglycemia was observed in 24% (28 individuals) of the patients. All showed a RH pattern with no symptoms. The RH group exhibited significantly elevated insulin levels at 1 hour. Furthermore, a significant increase in the white blood cell (WBC) count during OGTT was observed in the RH group compared with the non-RH group [delta WBC; RH: 4.84 (-4.17-20.75) versus non-RH: -2.17 (-9.23-9.09) %; P = 0.04].Asymptomatic RH and an augmentation of inflammation were observed at an incidence of 24% in CAD patients.(Int Heart J 2018; 59: 705-712)

Atherosclerosis Risk Factors in Patients with Reactive Hypoglycemia

“…10 All the defense mechanisms that prevent an individual from the negative consequences of hypoglycemia appear to be crucial in establishing prognosis in diabetic patients after acute coronary syndrome. 17 However, it remains unclear whether or not these defense, counterregulatory, mechanisms alter the prognosis in otherwise healthy patients who experience reactive hypoglycemia (RH), defined as blood glucose levels lower than 70 mg/dL that occurs 2-5 hours after a meal. 18,19 The potential role of RH in atherogenesis has not been thoroughly investigated.…”