Antidiabetic treatments and risk of hospitalisation with myocardial infarction: a nationwide case-control study

Purpose Data on cardiovascular risk associated with different types of antidiabetic treatments are sparse and conflicting. We examined the risk of hospitalisation with myocardial infarction (MI) among patients treated with sulfonylureas, metformin, insulin, any combination and no antidiabetic pharmacotherapy. Methods Using nationwide registries, we conducted a population-based nested case-control study among all patients with type 2 diabetes in Denmark and identified all patients hospitalised with a first-time MI and age-and gender-matched non-MI controls in the period 1996-2004. We estimated odds ratios (ORs) of MI according to type of antidiabetic treatment, adjusted for potential confounding factors using patients treated with sulfonylureas as the reference group. Results A total of 10 616 type 2 diabetic cases hospitalised with MI and 90 697 type 2 diabetic non-MI controls were available for analysis. We found a lower risk of hospitalisation with MI among users of metformin (adjusted OR = 0.86, 95% CI: 0.78-0.95), insulin (adjusted OR = 0.92, 95% CI: 0.86-0.99) and among patients not receiving any antidiabetic pharmacotherapy (adjusted OR = 0.75, 95% CI: 0.71-0.79) compared with users of sulfonylureas. Users of any combination had similar risk as users of sulfonylureas (adjusted OR = 0.99, 95% CI: 0.92-1.06). We found no differences between individual sulfonylureas, and glycaemic control and lipid profile had only minor impact on the risk estimates in subanalyses including HbA(1c), cholesterol and triglycerides. Conclusions Our findings provide some support for the hypothesis that sulfonylureas may be associated with an increased risk of hospitalisation with MI. Copyright (C) 2011 John Wiley & Sons, Ltd.