Results from a study suggest clinically important differences in the cardiovascular safety profiles of different anti diabetes drugs.
Researchers investigated the risk of heart attack, congestive heart failure and death from any cause associated with prescription of different types of oral anti diabetes drugs, and have found that sulfonylureas, a type of drug widely used to treat type 2 diabetes, carries a greater risk of heart failure and death compared with metformin, another popular anti diabetes drug.
Type 2 diabetes affects more than 180 million people worldwide and is associated with at least a two-fold increased risk of death, mainly from cardiovascular disease. Oral anti diabetes drugs are widely used to help control blood sugar levels, but there are concerns that some could increase cardiovascular risk.
The researchers used data from 91,521 men and women (average age 65 years) with diabetes included in the UK General Practice Research Database between 1990 and 2005. Factors that could potentially affect the results were taken into account.
Metformin was the most commonly prescribed drug (74.5% of patients), followed by second generation sulfonylureas (63.5%).
Compared with metformin, both first and second generation sulfonylureas were associated with significant (up to 61%) excess risk of all cause mortality, and second generation sulfonylureas with up to 30% excess risk of congestive heart failure.
Another class of anti diabetes drugs called thiazolidinediones were not associated with risk of heart attack, and there was significantly (up to 39%) lower risk of all cause mortality associated with pioglitazone use compared with metformin. Other studies have however suggested a link between treatment of diabetes with thiazolidinediones and increased risk of bone fractures (Diabetes Drug Associated With Risk of Bone Fractures and Type 2 Diabetes Thiazolidinediones Double the Risk of Fractures).
“The sulfonylureas, along with metformin, have long been considered the mainstay of drug treatment for type 2 diabetes. Our findings suggest a relatively unfavorable risk profile of sulfonylureas compared with metformin,” say the study authors.
References:
1. Paul Elliott , et al. Risk of cardiovascular disease and all cause mortality among patients with type 2 diabetes prescribed oral antidiabetes drugs: retrospective cohort study using UK general practice research database. British Medical Journal. BMJ 2009;339:b4731. December 2009, doi:10.1136/bmj.b4731.
