4.7 Article

Effects of Metformin Versus Glipizide on Cardiovascular Outcomes in Patients With Type 2 Diabetes and Coronary Artery Disease

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DIABETES CARE
卷 36, 期 5, 页码 1304-1311

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AMER DIABETES ASSOC
DOI: 10.2337/dc12-0719

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资金

  1. 863 Project [2006 AA 02A409]
  2. National Natural Science Foundation of China [30971077, 81170784]
  3. Shanghai Shenkang Hospital Development Center [Shdc12007309]
  4. Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Chinese Public Health [1994DP131044]
  5. National Key New Drug Creation and Manufacturing Program [2008ZX09312/019]
  6. Shanghai Committee on Science and Technology [10dz1920802]
  7. Program for Innovative Research Team of Shanghai Municipal Education Commission
  8. Sector Funds of Ministry of Health [201002002]
  9. National Key New Drug Creation and Manufacturing Program of Ministry of Science and Technology [2012ZX09303006-001]

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OBJECTIVE-The two major classes of antidiabetic drugs, sulfonylureas and metformin, may differentially affect macrovascular complications and mortality in diabetic patients. We compared the long-term effects of glipizide and metformin on the major cardiovascular events in type 2 diabetic patients who had a history of coronary artery disease (CAD). RESEARCH DESIGN AND METHODS-This study is a multicenter, randomized, doubleblind, placebo-controlled clinical trial. A total of 304 type 2 diabetic patients with CAD, mean age = 63.3 years (range, 36-80 years), were enrolled. Participants were randomly assigned to receive either glipizide (30 mg daily) or metformin (1.5 g daily) for 3 years. The primary end points were times to the composite of recurrent cardiovascular events, including death from a cardiovascular cause, death from any cause, nonfatal myocardial infarction, nonfatal stroke, or arterial revasculanzation. RESULTS-At the end of study drug administration, both groups achieved a significant decrease in the level of glycated hemoglobin (7.1% in the glipizide group and 7.0% in the metformin group). At a median follow-up of 5.0 years, 91 participants had developed 103 primary end points. Intention-to-treat analysis showed an adjusted hazard ratio (HR) of 0.54(95% Cl 0.30-0.90; P = 0.026) for the composites of cardiovascular events among the patients that received metformin, compared with glipizide. The secondary end points and adverse events were not significantly different between the two groups. CONCLUSIONS-Treatment with metformin for 3 years substantially reduced major cardiovascular events in a median follow-up of 5.0 years compared with glipizide. Our results indicated a potential benefit of metformin therapy on cardiovascular outcomes in high-risk patients.

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