期刊
ANNALS OF INTERNAL MEDICINE
卷 157, 期 9, 页码 601-+出版社
AMER COLL PHYSICIANS
DOI: 10.7326/0003-4819-157-9-201211060-00003
关键词
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资金
- Agency for Healthcare Research and Quality [290-05-0042]
- U.S. Department of Health and Human Services
- Veterans Affairs Career Development Awards [04-342-2, 2-031-09S]
- Vanderbilt Clinical Translational Scientist Award from National Center for Research Resources/National Institutes of Health [UL1 RR024975-01]
- Veterans Affairs Information Resource Center [SDR 02-237, 98-004]
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 A(1c), 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. Conclusion: Use of sulfonylureas compared with metformin for initial treatment of diabetes was associated with an increased hazard of CVD events or death.
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