VA Tennessee Valley Geriatric Research Education Clinical Center, HSR&D Targeted Research Enhancement Program for Patient Healthcare Behavior, Clinical Research Center of Excellence, Nashville, TN, USA.
Pharmacoepidemiol Drug Saf. 2011 Jan;20(1):36-44. doi: 10.1002/pds.2029. Epub 2010 Nov 12.
Effects of oral antidiabetic drugs (OADs) on lipids may influence cardiovascular outcomes. Our aim was to compare time to initiation of lipid lowering medication (LLM) and 12-month lipid profiles among new OAD users.
We identified a retrospective cohort of 17,774 veterans who received care at Veterans Administration (VA) Mid-South Network with a first OAD from 1 January 2000 to 31 December 2007. There were 6917 patients (38.9%) not on a LLM at baseline, and 3871 (56%) had complete covariates. Incident users of sulfonylurea and combination metformin + sulfonylurea were compared to metformin users for time to LLM initiation. Incident users of these OADs and thiazolidendiones were included in comparison of 12-month low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TGs), and total cholesterol. All analyses adjusted for demographics, lipids, HbA1C, healthcare utilization, and cardiovascular disease at baseline.
The median time to starting LLM was 2.35 years (interquartile range 0.96, 4.6) following metformin initiation and not statistically different for users of sulfonylureas, or combination OADs. Compared to metformin users, 12-month HDL was 1.35 mg/dl (95%CI: -2.01, -0.72) lower and TGs were 5.7% higher (95%CI: 1.5%, 10.0%) for sulfonylurea users; TGs were 24.8% (95%CI: 0.7%, 54.5%) higher for thiazolidinedione users. Statin users had LDL and total cholesterol 16.7 mg/dl (95%CI: -19.9, -13.5) and 18.6 mg/dl (95%CI: -22.1, -15.1) lower than non-statin users, respectively.
Time to LLM initiation was similar between OADs. Metformin use resulted in more favorable lipids at 12 months compared to sulfonylureas or thiazolidinediones.
口服降糖药（OAD）对血脂的影响可能会影响心血管结局。我们的目的是比较新 OAD 使用者开始使用降脂药物（LLM）的时间和 12 个月的血脂谱。
我们在退伍军人事务部（VA）中南部网络中确定了一个回顾性队列，该队列中的 17774 名患者在 2000 年 1 月 1 日至 2007 年 12 月 31 日期间首次接受 OAD 治疗。有 6917 名患者（38.9%）在基线时未服用 LLM，3871 名患者（56%）有完整的协变量。磺酰脲类药物和二甲双胍+磺酰脲类药物联合使用者与二甲双胍使用者相比，开始使用 LLM 的时间。将这些 OAD 和噻唑烷二酮类药物的新使用者纳入低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、甘油三酯（TGs）和总胆固醇的 12 个月比较。所有分析均根据人口统计学、血脂、糖化血红蛋白、医疗保健利用情况和基线时的心血管疾病进行了调整。
在开始使用二甲双胍后，开始使用 LLM 的中位数时间为 2.35 年（四分位距 0.96，4.6），磺酰脲类药物或联合 OAD 使用者之间无统计学差异。与二甲双胍使用者相比，磺酰脲类药物使用者的 12 个月 HDL 降低了 1.35mg/dl（95%CI：-2.01，-0.72），TG 升高了 5.7%（95%CI：1.5%，10.0%）；噻唑烷二酮类药物使用者的 TG 升高了 24.8%（95%CI：0.7%，54.5%）。他汀类药物使用者的 LDL 和总胆固醇分别比非他汀类药物使用者低 16.7mg/dl（95%CI：-19.9，-13.5）和 18.6mg/dl（95%CI：-22.1，-15.1）。
OAD 之间开始使用 LLM 的时间相似。与磺酰脲类药物或噻唑烷二酮类药物相比，使用二甲双胍在 12 个月时可使血脂更有利。
