New Findings Suggest Sulfonylureas are Associated with Increased Risk of Cardiovascular Events

New research from AHRQ’s Effective Health Care Program looks at the use of metformin and sulfonylureas among patients who are beginning to take oral medications to treat type 2 diabetes. In one of the first large-scale data analysis of its kind, researchers found that the use of sulfonylureas was associated with an increased risk of cardiovascular events – including death – among study patients when compared with the use of metformin. Further studies would be needed to clarify whether the difference in risk is due to harms from sulfonylureas, benefits from metformin, or both. These findings, which were published in the November 6 issue of Annals of Internal Medicine, support the use of metformin for first-line type 2 diabetes therapy for patients without other contraindications and contribute to the knowledge base about the cardiovascular advantages of metformin compared with sulfonylureas. Select to access the abstract on PubMed.®

Ann Intern Med. 2012 Nov 6;157(9):601-10. doi: 10.7326/0003-4819-157-9-201211060-00003.

Comparative effectiveness of sulfonylurea and metformin monotherapy on cardiovascular events in type 2 diabetes mellitus: a cohort study.

Roumie CL, Hung AM, Greevy RA, Grijalva CG, Liu X, Murff HJ, Elasy TA, Griffin MR.

Abstract

BACKGROUND:

The effects of sulfonylureas and metformin on outcomes of cardiovascular disease (CVD) in type 2 diabetes are not well-characterized.

OBJECTIVE:

To compare the effects of sulfonylureas and metformin on CVD outcomes (acute myocardial infarction and stroke) or death.

DESIGN:

Retrospective cohort study.

SETTING:

National Veterans Health Administration databases linked to Medicare files.

PATIENTS:

Veterans who initiated metformin or sulfonylurea therapy for diabetes. Patients with chronic kidney disease or serious medical illness were excluded.

MEASUREMENTS:

Composite outcome of hospitalization for acute myocardial infarction or stroke, or death, adjusted for baseline demographic characteristics; medications; cholesterol, hemoglobin A1c, and serum creatinine levels; blood pressure; body mass index; health care utilization; and comorbid conditions.

RESULTS:

Among 253 690 patients initiating treatment (98 665 with sulfonylurea therapy and 155 025 with metformin therapy), crude rates of the composite outcome were 18.2 per 1000 person-years in sulfonylurea users and 10.4 per 1000 person-years in metformin users (adjusted incidence rate difference, 2.2 [95% CI, 1.4 to 3.0] more CVD events with sulfonylureas per 1000 person-years; adjusted hazard ratio [aHR], 1.21 [CI, 1.13 to 1.30]). Results were consistent for both glyburide (aHR, 1.26 [CI, 1.16 to 1.37]) and glipizide (aHR, 1.15 [CI, 1.06 to 1.26]) in subgroups by CVD history, age, body mass index, and albuminuria; in a propensity score-matched cohort analysis; and in sensitivity analyses.

LIMITATION:

Most of the veterans in the study population were white men; data on women and minority groups were limited but reflective of the Veterans Health Administration population.