The Risk of Developing Coronary Artery Disease or Congestive Heart Failure, and Overall Mortality, in Type 2 Diabetic Patients Receiving Rosiglitazone, Pioglitazone, Metformin, or Sulfonylureas: A Retrospective Analysis

Acta Diabetol. 2009 Jun;46(2):145-54. doi: 10.1007/s00592-008-0090-3. Epub 2009 Feb 5.

Abstract

Oral anti-diabetic agents have been associated with adverse cardiovascular events in type 2 diabetes (DM2). We investigated the risk of coronary artery disease (CAD), congestive heart failure (CHF), and mortality using multivariable Cox models in a retrospective cohort of 20,450 DM2 patients from our electronic health record (EHR). We observed no differences in CAD risk among the agents. Metformin was associated with a reduced risk of CHF (HR 0.76, 95% CI 0.64-0.91) and mortality (HR 0.54, 95% CI 0.46-0.64) when compared to sulfonylurea. Pioglitazone was also associated with a lower risk of mortality when compared to sulfonylurea (HR 0.59, 95% CI 0.43-0.81). No other significant differences were found between the oral agents. In conclusions, our results did not identify an increased CAD risk with rosiglitazone in clinical practice. However, the results do reinforce a possible increased risk of adverse events in DM2 patients prescribed sulfonylureas.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Coronary Artery Bypass
  • Coronary Disease / epidemiology*
  • Coronary Disease / mortality
  • Coronary Disease / surgery
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetic Angiopathies / epidemiology*
  • Diabetic Angiopathies / mortality
  • Female
  • Heart Failure / epidemiology*
  • Heart Failure / mortality
  • Humans
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / therapeutic use*
  • Male
  • Metformin / adverse effects
  • Metformin / therapeutic use
  • Multivariate Analysis
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Rosiglitazone
  • Smoking / epidemiology
  • Sulfonylurea Compounds / adverse effects
  • Sulfonylurea Compounds / therapeutic use
  • Survival Analysis
  • Survivors
  • Thiazolidinediones / adverse effects
  • Thiazolidinediones / therapeutic use

Substances

  • Angiotensin-Converting Enzyme Inhibitors
  • Hypoglycemic Agents
  • Sulfonylurea Compounds
  • Thiazolidinediones
  • Rosiglitazone
  • Metformin