Author + information
- Ulrik Madvig Mogensen,
- Charlotte Andersson,
- Emil Loldrup Fosbøl,
- Tina Kenn Schramm,
- Allan Vaag,
- Nicolai Scheller,
- Christian Torp-Pedersen,
- Gunnar Gislason and
- Lars Kober
Sulfonylurea (SU) in combination with metformin has been associated with increased mortality and cardiovascular (CV) risk when compared with SU alone. In a nationwide study, we investigated the risk associated with all individual SUs when used in combination with metformin.
All Danish individuals aged ≥ 18 initiating glucose-lowering therapy from 1997-2010 were followed by individual-level linkage of nationwide registries. All-cause mortality, CV mortality and the composite of acute myocardial infarction, stroke and CV mortality was compared. Rate ratios (RR) were calculated using time-dependent multivariable Poisson regression analysis (including age, diabetes duration, comorbidity, calendar year and CV drugs) with gliclazid-metformin as the comparator group.
Of 202,272 patients initiating glucose-lowering therapy without prior myocardial infarction or stroke, 63,475 patients received a combination of metformin and SU and 3212 died during relevant treatment. Glipizide-metformin was associated with increased risk of all-cause mortality (RR 1.20 [1.02-1.41]), CV mortality (RR 1.35 [1.05-1.75]) and the composite endpoint (Figure 1). Combinations with glibenclamide, tolbutamide and glimepiride were associated with higher RRs, whereas repaglinide had lower RR, however these differences were non-significant.
Glipizide appears to be associated with an increased risk compared with gliclazide when used in combination with metformin.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Prevention: Diabetes and Risk
Abstract Category: 24. Prevention: Clinical
Presentation Number: 1185-6
- 2013 American College of Cardiology Foundation