Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
Diabetes Care. 2017 Nov;40(11):1506-1513. doi: 10.2337/dc17-0595. Epub 2017 Sep 1.
Sulfonylureas have been associated with an increased risk of cardiovascular adverse events and hypoglycemia, but it is unclear if these risks vary with different agents. We assessed whether the risks of acute myocardial infarction, ischemic stroke, cardiovascular death, all-cause mortality, and severe hypoglycemia differ between sulfonylureas grouped according to pancreas specificity and duration of action.
Using the U.K. Clinical Practice Research Datalink, linked with the Hospital Episodes Statistics and the Office for National Statistics databases, we conducted a cohort study among patients with type 2 diabetes initiating monotherapy with sulfonylureas between 1998 and 2013. Adjusted hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards models, comparing use of pancreas-nonspecific, long-acting sulfonylureas (glyburide/glimepiride) to pancreas-specific, short-acting sulfonylureas (gliclazide/glipizide/tolbutamide).
The cohort included 17,604 sulfonylurea initiators (mean [SD] follow-up 1.2 [1.5] years). Compared with specific, short-acting sulfonylureas (15,741 initiators), nonspecific, long-acting sulfonylureas (1,863 initiators) were not associated with an increased risk of acute myocardial infarction (HR 0.86; CI 0.55-1.34), ischemic stroke (HR 0.92; CI 0.59-1.45), cardiovascular death (HR 1.01; CI 0.72-1.40), or all-cause mortality (HR 0.81; CI 0.66-1.003), but with an increased risk of severe hypoglycemia (HR 2.83; CI 1.64-4.88).
The nonspecific, long-acting sulfonylureas glyburide and glimepiride do not have an increased risk of cardiovascular adverse events compared with the specific, short-acting sulfonylureas gliclazide, glipizide, and tolbutamide. However, nonspecific, long-acting sulfonylureas glyburide and glimepiride have an increased risk of severe hypoglycemia.
磺酰脲类药物与心血管不良事件和低血糖风险增加有关，但尚不清楚这些风险是否因不同药物而有所不同。我们评估了根据胰腺特异性和作用持续时间分组的磺酰脲类药物之间，急性心肌梗死、缺血性卒中等心血管不良事件的风险、全因死亡率和严重低血糖是否存在差异。
利用英国临床实践研究数据链接，与医院发病统计和国家统计局数据库链接，我们对 1998 年至 2013 年间使用磺酰脲类药物单药治疗的 2 型糖尿病患者进行了队列研究。使用 Cox 比例风险模型估计调整后的风险比（HR）和 95%置信区间（CI），比较胰腺非特异性、长效磺酰脲类药物（格列吡嗪/格列美脲）与胰腺特异性、短效磺酰脲类药物（格列齐特/格列吡嗪/甲苯磺丁脲）的使用情况。
该队列包括 17604 名磺酰脲类药物起始者（平均[标准差]随访时间为 1.2[1.5]年）。与特异性、短效磺酰脲类药物（15741 名起始者）相比，非特异性、长效磺酰脲类药物（1863 名起始者）并未增加急性心肌梗死（HR 0.86；CI 0.55-1.34）、缺血性卒中等心血管不良事件的风险（HR 0.92；CI 0.59-1.45）、心血管死亡（HR 1.01；CI 0.72-1.40）或全因死亡率（HR 0.81；CI 0.66-1.003），但严重低血糖（HR 2.83；CI 1.64-4.88）的风险增加。
与特异性、短效磺酰脲类药物（格列齐特、格列吡嗪和甲苯磺丁脲）相比，非特异性、长效磺酰脲类药物（格列吡嗪/格列美脲）不会增加心血管不良事件的风险。然而，非特异性、长效磺酰脲类药物（格列吡嗪/格列美脲）严重低血糖的风险增加。
