Severe Hypoglycemia and Risk of Atherosclerotic Cardiovascular Disease in Patients With Diabetes.

Meta-analyses and reviews of observational cohorts have reported a relationship between severe hypoglycemia (SH) and atherosclerotic cardiovascular disease (ASCVD) events, but estimates of effect vary widely and many studies are limited by size and diversity, ability to adjust for confounders, and inconsistent definitions of exposures and outcomes (1–4). We studied the association of SH events and risk of ASCVD in a large, diverse cohort of patients. This study was approved by the Kaiser Permanente Northern California (KPNC) Institutional Review Board. This observational cohort study included adults (age ≥18 years) with diabetes who were members of KPNC, an integrated health care delivery system, with continuous membership during the 2 years prior to baseline. The outcomes of interest were ASCVD events, defined as a composite of nonfatal myocardial infarction, fatal or nonfatal ischemic stroke, or death due to coronary heart disease. The exposure of interest …