Sulphonylureas and cardiovascular (CV) risk

• since publication of the results of the University Group Diabetes Project (UGDP), the relationship between the use of sulphonylureas and increased cardiovascular risk has been questioned
  • patients treated with tolbutamide in the UGDP had a significantly higher cardiovascular rate of death than those given placebo (1)
• a retrospective, inception cohort study investigating the use of oral hypoglycaemic agents and risk of cardiovascular disease has been undertaken (2)
  • study involved 5795 subjects - identified by their first-ever dispensation for an oral antidiabetic agent and grouped according to their use of such agents during follow-up
  • the study findings revealed that higher exposure to sulphonylureas was associated with increased mortality among patients newly treated for type 2 diabetes. The same relation was not observed with metformin

Reference:

1. Meinert CL et al. A study of the effects of hypoglycemic agents on vascular complications in patients with adult-onset diabetes. II. Mortality results. Diabetes 1970;19(Suppl):789-830.
2. Simpson SH et al. Dose-response relation between sulfonylurea drugs and mortality in type 2 diabetes mellitus: a population based cohort study. CMAJ 2006;174:169-74