Western University of Health Sciences, College of Pharmacy, Pomona; Western Diabetes Institute, Pomona, CA.
Diabet Med. 2013 Oct;30(10):1160-71. doi: 10.1111/dme.12232.
Sulphonylurea use has been linked with increased cardiovascular disease risk; however, previous studies have been inconsistent. Type 2 diabetes independently increases risk for cardiovascular disease, so understanding the link between longer-term use of anti-diabetic medications and cardiovascular disease has important clinical implications.
Literature search in MEDLINE and CENTRAL was conducted throughout December 2011 for clinical and observational studies that reported the association between sulphonylurea and cardiovascular disease events. Ratios (relative risk, odds ratios or hazard ratios) adjusted for potential confounders (concomitant medications, baseline cardiovascular risk, diabetes severity) were pooled using a random-effects model to yield relative risks and associated 95% confidence intervals.
This meta-analysis included 33 studies (n = 1,325,446 patients), followed for a range of 0.46-10.4 years. In all studies, compared with other oral diabetes drugs, sulphonylurea use was associated with a significantly increased risk of cardiovascular death (relative risk 1.27, 95% confidence interval 1.18-1.34, n = 27 comparisons) and composite cardiovascular event (including myocardial infarction, stroke, cardiovascular-related hospitalization or cardiovascular death) (relative risk 1.10, 95% confidence interval 1.04-1.16, n = 43 comparisons). In studies comparing sulphonylurea vs. metformin, these relative risks were 1.26 (95% confidence interval 1.17-1.35, n = 17 comparisons) and 1.18 (95%confidence interval 1.13-1.24, n = 16 comparisons), respectively.
Results suggest that sulphonylurea use may elevate the risk of cardiovascular disease among patients with diabetes. This meta-analysis expands the pool of studies evaluating cardiovascular mortality compared with prior observations while using adjusted estimates, and assessing an additional outcome of a composite cardiovascular event. This finding warrants consideration in clinical practice when other treatment options may be available.
磺酰脲类药物的使用与心血管疾病风险增加有关；然而，先前的研究结果并不一致。2 型糖尿病本身会增加心血管疾病的风险，因此了解长期使用抗糖尿病药物与心血管疾病之间的联系具有重要的临床意义。
在 2011 年 12 月期间，在 MEDLINE 和 CENTRAL 中进行了文献检索，以查找报告磺酰脲类药物与心血管疾病事件之间关联的临床和观察性研究。使用随机效应模型汇总了经过潜在混杂因素（同时使用的药物、基线心血管风险、糖尿病严重程度）调整的比值比（相对风险、优势比或风险比），以得出相对风险及其相关的 95%置信区间。
本荟萃分析纳入了 33 项研究（n = 1,325,446 例患者），随访时间为 0.46-10.4 年。在所有研究中，与其他口服糖尿病药物相比，磺酰脲类药物的使用与心血管死亡风险显著增加相关（相对风险 1.27，95%置信区间 1.18-1.34，n = 27 项比较）和复合心血管事件（包括心肌梗死、中风、与心血管相关的住院或心血管死亡）（相对风险 1.10，95%置信区间 1.04-1.16，n = 43 项比较）。在比较磺酰脲类药物与二甲双胍的研究中，这些相对风险分别为 1.26（95%置信区间 1.17-1.35，n = 17 项比较）和 1.18（95%置信区间 1.13-1.24，n = 16 项比较）。
结果表明，磺酰脲类药物的使用可能会增加糖尿病患者发生心血管疾病的风险。与之前的观察结果相比，本荟萃分析扩大了评估心血管死亡率的研究范围，同时使用了调整后的估计值，并评估了复合心血管事件的额外结局。这一发现值得在临床实践中考虑，因为可能有其他治疗选择。
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