Sulfonylurea Use: Cardiovascular Disease & Type 2 Diabetes

Research Paper Title

Sulfonylurea Use and Incident Cardiovascular Disease Among Patients With Type 2 Diabetes: Prospective Cohort Study Among Women.

Background

Evidence is inconsistent for the association between sulfonylurea use and risk of cardiovascular disease among patients with diabetes. The researchers aimed to prospectively evaluate this association using the Nurses’ Health Study (NHS), a well-established cohort of US women with long-term follow-up.

Methods

The researchers followed 4,902 women (mean age 68 years) with diabetes (mean duration 11 years), but without cardiovascular disease at baseline. The use of sulfonylureas and other medications was self-reported at baseline and during the follow-up period of up to 10 years. Cox proportional hazard regression models were used to estimate the relative risk (RR) and 95% CI for the association between the sulfonylurea use and incident cardiovascular disease while accounting for potential confounders, including age, diabetes duration, diabetes-related complications, other antihyperglycemic medications, BMI, lifestyle factors, family history of cardiovascular diseases, and present chronic conditions. The researchers also applied the propensity score stratification method to address the possibility of residual confounding.

Results

The researchers identified 339 incident cases of cardiovascular disease, including 191 cases of coronary heart disease (CHD) and 148 cases of stroke. A longer duration of sulfonylurea use was significantly associated with a higher risk of CHD (P for trend = 0.002); the RRs for CHD were 1.24 (95% CI 0.85–1.81) for patients who used sulfonylurea therapy for 1–5 years, 1.51 (0.94–2.42) for 6–10 years, and 2.15 (1.31–3.54) for >10 years, compared with nonusers. Compared with users of metformin monotherapy, the RR for CHD was 3.27 (1.31–8.17) for those who were treated with the combination of metformin and sulfonylurea. The analysis using propensity score stratification yielded similar results. The researchers did not observe a significant association between sulfonylurea therapy and stroke risk.

Reference

Li, Y., Hu, Y., Ley, S.H. Rajpathak, S. & Hu, F.B. (2014) Sulfonylurea Use and Incident Cardiovascular Disease Among Patients With Type 2 Diabetes: Prospective Cohort Study Among Women. Diabetes Care. Published online before print August 22, 2014, doi:10.2337/dc14-1306.

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