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This risk is especially high in individuals with significant vascular risk, such as older adults and those with multiple cardiovascular risk factors. Hypoglycemia triggers several pathophysiological changes that increase cardiovascular risk. These include activation of the sympathoadrenal system, promotion of proinflammatory and prothrombotic states, arrhythmogenic changes, and increased hemodynamic stress. Experimental evidence shows that recurrent hypoglycemia worsens microvascular dysfunction and promotes adverse cardiac remodeling, especially in people with diabetes. While the link between hypoglycemia and cardiovascular events is well established, the causality remains debated. Hypoglycemia may directly contribute to cardiovascular disease or indicate underlying vulnerability, especially in patients with advanced disease or comorbidities. Minimizing hypoglycemic episodes is recommended for all patients with diabetes, particularly those with established cardiovascular disease, due to the clear association with adverse outcomes.<\/jats:p>","DOI":"10.3389\/fcdhc.2026.1765597","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T05:23:16Z","timestamp":1770268996000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical and pathophysiological links between hypoglycemia and cardiovascular risk in type 2 diabetes mellitus"],"prefix":"10.3389","volume":"7","author":[{"given":"Lamija","family":"Ferhatbegovi\u0107","sequence":"first","affiliation":[{"name":"Department of General Internal Medicine, Cantonal Hospital Zenica","place":["Zenica, Bosnia and Herzegovina"]},{"name":"Medical Faculty, University of Zenica","place":["Zenica, Bosnia and Herzegovina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minela","family":"Be\u0107irovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Internal Diseases, University Clinical Center Tuzla","place":["Tuzla, Bosnia and Herzegovina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emir","family":"Be\u0107irovi\u0107","sequence":"additional","affiliation":[{"name":"Medical Faculty, University of Zenica","place":["Zenica, Bosnia and Herzegovina"]},{"name":"Clinic for Internal Diseases, University Clinical Center Tuzla","place":["Tuzla, Bosnia and Herzegovina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumeja","family":"Sarajli\u0107","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Cantonal Hospital Zenica","place":["Zenica, Bosnia and Herzegovina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aida","family":"Ribi\u0107","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, General Hospital \u201cPrim.dr. 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