Department of Medicine, University of Toronto, Toronto, ON, Canada.
Diabet Med. 2012 Dec;29(12):1524-8. doi: 10.1111/j.1464-5491.2012.03772.x.
Sulphonylureas promote insulin release by inhibiting pancreatic potassium channels. Older sulphonylureas such as glyburide (glibenclamide), but not newer ones such as gliclazide, antagonize similar channels in myocardium, interfering with the protective effects of ischaemic preconditioning. Whether this imparts a higher risk of adverse cardiac events is unknown.
We conducted a population-based cohort study of patients aged 66 years and older who were hospitalized for acute myocardial infarction or who underwent percutaneous coronary intervention between 1 April 2007 and 31 March 2010 while receiving either glyburide or gliclazide. We used a high-dimensional propensity score matching process to ensure similarity of glyburide- and gliclazide-treated patients. The primary outcome was a composite of death or hospitalization for myocardial infarction or heart failure.
During the 2-year study period, we matched 1690 patients treated with glyburide to 984 patients treated with gliclazide at the time of hospitalization for acute myocardial infarction or percutaneous coronary intervention. We found no difference in the risk of the composite outcome among patients receiving glyburide (adjusted hazard ratio 1.01; 95% CI 0.86-1.18). We found similar results in secondary analyses of each outcome individually, and in two supplementary analyses (haemorrhage and pneumonia) in which we anticipated no difference between the two patient groups.
Among older patients hospitalized for acute myocardial infarction or percutaneous coronary intervention, treatment with glyburide is not associated with an increased risk of future adverse cardiovascular events relative to gliclazide, suggesting that the effect of glyburide on ischaemic preconditioning is of little clinical relevance.
磺酰脲类药物通过抑制胰腺钾通道来促进胰岛素释放。像格列本脲（glyburide）这样的老一代磺酰脲类药物，但不是像格列齐特（gliclazide）这样的新一代磺酰脲类药物，会拮抗心肌中类似的通道，干扰缺血预处理的保护作用。这种作用是否会增加不良心脏事件的风险尚不清楚。
我们对 2007 年 4 月 1 日至 2010 年 3 月 31 日期间因急性心肌梗死住院或接受经皮冠状动脉介入治疗的年龄在 66 岁及以上的患者进行了一项基于人群的队列研究，这些患者在接受治疗时正在服用格列本脲或格列齐特。我们使用高维倾向评分匹配过程来确保格列本脲和格列齐特治疗患者的相似性。主要结局是死亡或因心肌梗死或心力衰竭住院的复合结局。
在 2 年的研究期间，我们将 1690 名接受格列本脲治疗的患者与 984 名在急性心肌梗死或经皮冠状动脉介入治疗时接受格列齐特治疗的患者进行了匹配。我们发现接受格列本脲治疗的患者复合结局风险没有差异（调整后的危险比为 1.01；95%CI 0.86-1.18）。我们在对每个结局进行的二次分析中发现了类似的结果，在我们预计两组患者之间没有差异的两项补充分析（出血和肺炎）中也发现了类似的结果。
在因急性心肌梗死或经皮冠状动脉介入治疗而住院的老年患者中，与格列齐特相比，接受格列本脲治疗与未来不良心血管事件的风险增加无关，这表明格列本脲对缺血预处理的影响在临床上意义不大。
