Cargando…

Comparative Safety of Sulfonylurea and Metformin Monotherapy on the Risk of Heart Failure: A Cohort Study

BACKGROUND: Medications that impact insulin sensitivity or cause weight gain may increase heart failure risk. Our aim was to compare heart failure and cardiovascular death outcomes among patients initiating sulfonylureas for diabetes mellitus treatment versus metformin. METHODS AND RESULTS: National...

Descripción completa

Detalles Bibliográficos
Autores principales: Roumie, Christianne L., Min, Jea Young, D'Agostino McGowan, Lucy, Presley, Caroline, Grijalva, Carlos G., Hackstadt, Amber J., Hung, Adriana M., Greevy, Robert A., Elasy, Tom, Griffin, Marie R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5533028/
https://www.ncbi.nlm.nih.gov/pubmed/28424149
http://dx.doi.org/10.1161/JAHA.116.005379
_version_ 1783253566526324736
author Roumie, Christianne L.
Min, Jea Young
D'Agostino McGowan, Lucy
Presley, Caroline
Grijalva, Carlos G.
Hackstadt, Amber J.
Hung, Adriana M.
Greevy, Robert A.
Elasy, Tom
Griffin, Marie R.
author_facet Roumie, Christianne L.
Min, Jea Young
D'Agostino McGowan, Lucy
Presley, Caroline
Grijalva, Carlos G.
Hackstadt, Amber J.
Hung, Adriana M.
Greevy, Robert A.
Elasy, Tom
Griffin, Marie R.
author_sort Roumie, Christianne L.
collection PubMed
description BACKGROUND: Medications that impact insulin sensitivity or cause weight gain may increase heart failure risk. Our aim was to compare heart failure and cardiovascular death outcomes among patients initiating sulfonylureas for diabetes mellitus treatment versus metformin. METHODS AND RESULTS: National Veterans Health Administration databases were linked to Medicare, Medicaid, and National Death Index data. Veterans aged ≥18 years who initiated metformin or sulfonylureas between 2001 and 2011 and whose creatinine was <1.4 (females) or 1.5 mg/dL (males) were included. Each metformin patient was propensity score‐matched to a sulfonylurea initiator. The outcome was hospitalization for acute decompensated heart failure as the primary reason for admission or a cardiovascular death. There were 126 867 and 79 192 new users of metformin and sulfonylurea, respectively. Propensity score matching yielded 65 986 per group. Median age was 66 years, and 97% of patients were male; hemoglobin A(1c) 6.9% (6.3, 7.7); body mass index 30.7 kg/m(2) (27.4, 34.6); and 6% had heart failure history. There were 1236 events (1184 heart failure hospitalizations and 52 cardiovascular deaths) among sulfonylurea initiators and 1078 events (1043 heart failure hospitalizations and 35 cardiovascular deaths) among metformin initiators. There were 12.4 versus 8.9 events per 1000 person‐years of use (adjusted hazard ratio 1.32, 95%CI 1.21, 1.43). The rate difference was 4 heart failure hospitalizations or cardiovascular deaths per 1000 users of sulfonylureas versus metformin annually. CONCLUSIONS: Predominantly male patients initiating treatment for diabetes mellitus with sulfonylurea had a higher risk of heart failure and cardiovascular death compared to similar patients initiating metformin.
format Online
Article
Text
id pubmed-5533028
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-55330282017-08-14 Comparative Safety of Sulfonylurea and Metformin Monotherapy on the Risk of Heart Failure: A Cohort Study Roumie, Christianne L. Min, Jea Young D'Agostino McGowan, Lucy Presley, Caroline Grijalva, Carlos G. Hackstadt, Amber J. Hung, Adriana M. Greevy, Robert A. Elasy, Tom Griffin, Marie R. J Am Heart Assoc Original Research BACKGROUND: Medications that impact insulin sensitivity or cause weight gain may increase heart failure risk. Our aim was to compare heart failure and cardiovascular death outcomes among patients initiating sulfonylureas for diabetes mellitus treatment versus metformin. METHODS AND RESULTS: National Veterans Health Administration databases were linked to Medicare, Medicaid, and National Death Index data. Veterans aged ≥18 years who initiated metformin or sulfonylureas between 2001 and 2011 and whose creatinine was <1.4 (females) or 1.5 mg/dL (males) were included. Each metformin patient was propensity score‐matched to a sulfonylurea initiator. The outcome was hospitalization for acute decompensated heart failure as the primary reason for admission or a cardiovascular death. There were 126 867 and 79 192 new users of metformin and sulfonylurea, respectively. Propensity score matching yielded 65 986 per group. Median age was 66 years, and 97% of patients were male; hemoglobin A(1c) 6.9% (6.3, 7.7); body mass index 30.7 kg/m(2) (27.4, 34.6); and 6% had heart failure history. There were 1236 events (1184 heart failure hospitalizations and 52 cardiovascular deaths) among sulfonylurea initiators and 1078 events (1043 heart failure hospitalizations and 35 cardiovascular deaths) among metformin initiators. There were 12.4 versus 8.9 events per 1000 person‐years of use (adjusted hazard ratio 1.32, 95%CI 1.21, 1.43). The rate difference was 4 heart failure hospitalizations or cardiovascular deaths per 1000 users of sulfonylureas versus metformin annually. CONCLUSIONS: Predominantly male patients initiating treatment for diabetes mellitus with sulfonylurea had a higher risk of heart failure and cardiovascular death compared to similar patients initiating metformin. John Wiley and Sons Inc. 2017-04-19 /pmc/articles/PMC5533028/ /pubmed/28424149 http://dx.doi.org/10.1161/JAHA.116.005379 Text en © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Roumie, Christianne L.
Min, Jea Young
D'Agostino McGowan, Lucy
Presley, Caroline
Grijalva, Carlos G.
Hackstadt, Amber J.
Hung, Adriana M.
Greevy, Robert A.
Elasy, Tom
Griffin, Marie R.
Comparative Safety of Sulfonylurea and Metformin Monotherapy on the Risk of Heart Failure: A Cohort Study
title Comparative Safety of Sulfonylurea and Metformin Monotherapy on the Risk of Heart Failure: A Cohort Study
title_full Comparative Safety of Sulfonylurea and Metformin Monotherapy on the Risk of Heart Failure: A Cohort Study
title_fullStr Comparative Safety of Sulfonylurea and Metformin Monotherapy on the Risk of Heart Failure: A Cohort Study
title_full_unstemmed Comparative Safety of Sulfonylurea and Metformin Monotherapy on the Risk of Heart Failure: A Cohort Study
title_short Comparative Safety of Sulfonylurea and Metformin Monotherapy on the Risk of Heart Failure: A Cohort Study
title_sort comparative safety of sulfonylurea and metformin monotherapy on the risk of heart failure: a cohort study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5533028/
https://www.ncbi.nlm.nih.gov/pubmed/28424149
http://dx.doi.org/10.1161/JAHA.116.005379
work_keys_str_mv AT roumiechristiannel comparativesafetyofsulfonylureaandmetforminmonotherapyontheriskofheartfailureacohortstudy
AT minjeayoung comparativesafetyofsulfonylureaandmetforminmonotherapyontheriskofheartfailureacohortstudy
AT dagostinomcgowanlucy comparativesafetyofsulfonylureaandmetforminmonotherapyontheriskofheartfailureacohortstudy
AT presleycaroline comparativesafetyofsulfonylureaandmetforminmonotherapyontheriskofheartfailureacohortstudy
AT grijalvacarlosg comparativesafetyofsulfonylureaandmetforminmonotherapyontheriskofheartfailureacohortstudy
AT hackstadtamberj comparativesafetyofsulfonylureaandmetforminmonotherapyontheriskofheartfailureacohortstudy
AT hungadrianam comparativesafetyofsulfonylureaandmetforminmonotherapyontheriskofheartfailureacohortstudy
AT greevyroberta comparativesafetyofsulfonylureaandmetforminmonotherapyontheriskofheartfailureacohortstudy
AT elasytom comparativesafetyofsulfonylureaandmetforminmonotherapyontheriskofheartfailureacohortstudy
AT griffinmarier comparativesafetyofsulfonylureaandmetforminmonotherapyontheriskofheartfailureacohortstudy