Key takeaways:
- Sulfonylureas have been linked to threat for coronary heart occasions vs. DPP-IVs for sufferers with kind 2 diabetes at reasonable CV threat.
- Threat ranged from 4% for glyburide to 13% for glipizide.
Generally used sulfonylureas have been related to an as much as 13% improve in threat for main antagonistic CV occasions vs. dipeptidyl-peptidase IV inhibitors in sufferers with kind 2 diabetes and reasonable CV threat, researchers reported.
“Sulfonylureas stay a typical selection of pharmacotherapy of kind 2 diabetes, due partially to their low value and glucose-lowering efficiency. Prior to now, particular person sulfonylureas which are now not out there within the U.S. (eg, tolbutamide) have been discovered to extend the chance of cardiovascular occasions,” Alexander Turchin, MD, MS, director of high quality in diabetes at Brigham and Girls’s Hospital and affiliate professor of drugs at Harvard Medical College, and colleagues wrote. “It isn’t recognized whether or not remedy with any sulfonylureas at present in scientific use will increase cardiovascular threat in contrast with different therapeutic alternate options.”
Alexander Turchin
Researchers performed a multicenter observational research that included 48,165 people with kind 2 diabetes and reasonable CV threat (median age, 61 years; 47% girls; median HbA1c, 7.8%) to emulate a trial evaluating incidence of CV occasions after initiation of remedy with particular person sulfonylureas and dipeptidyl-peptidase IV (DPP-IV) inhibitors as a second-line agent after metformin. The researchers outlined reasonable CV threat as having no prior prognosis of atherosclerotic CVD or HF hospitalization and both males aged no less than 35 years and ladies aged no less than 45 years or males aged 30 to 34 years and ladies aged 30 to 44 years with hypertension, hyperlipidemia, retinopathy, kidney illness or neuropathy.
Every participant initiated one of many following drugs after metformin: glimepiride, glipizide, glyburide or any DPP-IV inhibitor, together with alogliptin, linagliptin or sitagliptin (Januvia, Merck). The DPP-IV inhibitor saxagliptin was excluded from the research on account of prior analysis revealed in The New England Journal of Medication displaying the drug was related to elevated threat for HF.
The first final result was a composite of main antagonistic CV occasions together with MI, ischemic stroke, HF hospitalization or CV loss of life.
The outcomes have been revealed in JAMA Community Open.
Throughout a median follow-up of 37 months, 6.6% of people skilled a serious antagonistic CV occasion.
The researchers estimated the 5-year threat for main antagonistic CV occasions amongst sufferers with kind 2 diabetes and reasonable CV threat:
- 8.1% for DPP-IV inhibitors (95% CI, 7.5%-8.7%);
- 8.4% for glyburide (95% CI, 6.8%-9.9%);
- 8.6% for glimepiride (95% CI, 7.9%-9.2%); and
- 9.1% for glipizide (95% CI, 8.7%-9.7%).
In contrast with DPP-IV inhibitors, the 5-year threat ratio for the first outcomes was 1.13 for glipizide (95% CI, 1.03-1.23), 1.07 for glimepiride (95% CI, 0.96-1.16) and 1.04 for glyburide (95% CI, 0.83-1.24), in response to the research.
“A 13% relative improve in cardiovascular threat, just like the one estimated on this research, is doubtlessly clinically impactful. Decreases in cardiovascular threat of this magnitude have usually been considered enough for approval of medicines for prevention of cardiovascular occasions, significantly in high-risk inhabitants,” the researchers wrote. “This research’s findings due to this fact counsel warning in prescribing glipizide to people at reasonable cardiovascular threat or established atherosclerotic heart problems.”
Reference:
Sources/Disclosures
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Disclosures:
Turchin studies receiving grants from Eli Lilly and private charges from Novo Nordisk and Proteomics Worldwide. Please see the research for all different authors’ related monetary disclosures.
