Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Pharmacoepidemiol Drug Saf. 2011 Apr;20(4):331-7. doi: 10.1002/pds.2097. Epub 2011 Jan 10.
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.
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.
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.
Our findings provide some support for the hypothesis that sulfonylureas may be associated with an increased risk of hospitalisation with MI.
关于不同类型抗糖尿病治疗与心血管风险的相关数据较为匮乏且相互矛盾。我们研究了丹麦所有 2 型糖尿病患者中，使用磺酰脲类、二甲双胍、胰岛素、任何联合治疗以及未进行任何抗糖尿病药物治疗的患者发生心肌梗死（MI）住院的风险。
利用全国性登记处，我们对丹麦的所有 2 型糖尿病患者进行了一项基于人群的巢式病例对照研究，确定了在 1996 年至 2004 年期间首次因 MI 住院的患者以及年龄和性别相匹配的非 MI 对照组。我们根据抗糖尿病治疗类型估计了 MI 的比值比（OR），使用磺酰脲类作为参考组，通过调整潜在混杂因素来调整 OR。
共纳入 10616 例 2 型糖尿病并发 MI 住院患者和 90697 例 2 型糖尿病非 MI 对照组。我们发现，与使用磺酰脲类药物的患者相比，使用二甲双胍（调整 OR=0.86，95%CI：0.78-0.95）、胰岛素（调整 OR=0.92，95%CI：0.86-0.99）以及未接受任何抗糖尿病药物治疗的患者（调整 OR=0.75，95%CI：0.71-0.79）的 MI 住院风险较低。与使用磺酰脲类药物的患者相比，任何联合治疗药物的使用患者的风险相似（调整 OR=0.99，95%CI：0.92-1.06）。我们没有发现个体磺酰脲类药物之间的差异，并且血糖控制和血脂谱在包括 HbA1c、胆固醇和甘油三酯在内的亚分析中对风险估计的影响较小。
我们的研究结果为磺酰脲类药物可能与 MI 住院风险增加相关的假说提供了一些支持。
