Are Users of Sulphonylureas at the Time of an Acute Coronary Syndrome at Risk of Poorer Outcomes?

Diabetes Obes Metab. 2013 Nov;15(11):1022-8. doi: 10.1111/dom.12126. Epub 2013 Jun 3.

Abstract

Aims: Adenosine triphosphate sensitive potassium (K(ATP)) channel activity is cardioprotective during ischaemia. One of the purported mechanisms for sulphonylurea adverse effects is through inhibition of these channels. The purpose of this study is to examine whether patients using K(ATP) channel inhibitors at the time of an acute coronary syndrome are at greater risk of death or heart failure (HF) than those not exposed.

Methods: Using linked administrative databases we identified all adults who had an acute coronary syndrome between April 2002 and October 2006 (n = 21 023).

Results: Within 30 days of acute coronary syndrome, 5.3% of our cohort died and 15.6% were diagnosed with HF. Individuals with diabetes exhibited significantly higher risk of death (adjusted OR: 1.20, 95% CI: 1.03-1.40) and death or HF (aOR: 1.73, 95% CI: 1.59-1.89) than individuals without diabetes. However, there was no significantly increased risk of death (aOR: 1.00, 95% CI: 0.76-1.33) or death/HF (aOR: 1.06, 95% CI: 0.89-1.26) in patients exposed to K(ATP) channel inhibitors versus patients not exposed to K(ATP) channel inhibitors prior to their acute coronary syndrome.

Conclusions: Diabetes is associated with an increased risk of death or HF within 30 days of an acute coronary syndrome. However, we did not find any excess risk of death or HF associated with use of K(ATP) channel inhibitors at the time of an acute coronary syndrome, raising doubts about the hypothesis that sulphonylureas inhibit the cardioprotective effects of myocardial K(ATP) channels.

Keywords: cardiovascular disease; diabetes mellitus; sulphonylureas.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / complications
  • Acute Coronary Syndrome / diagnosis
  • Acute Coronary Syndrome / mortality
  • Acute Coronary Syndrome / physiopathology*
  • Aged
  • Aged, 80 and over
  • Alberta / epidemiology
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetic Cardiomyopathies / diagnosis
  • Diabetic Cardiomyopathies / metabolism
  • Diabetic Cardiomyopathies / mortality
  • Diabetic Cardiomyopathies / physiopathology*
  • Female
  • Heart Failure / etiology
  • Humans
  • Hypoglycemic Agents / adverse effects*
  • Hypoglycemic Agents / therapeutic use
  • KATP Channels / antagonists & inhibitors
  • KATP Channels / metabolism
  • Logistic Models
  • Male
  • Medical Record Linkage
  • Mortality
  • Potassium Channel Blockers / adverse effects*
  • Potassium Channel Blockers / therapeutic use
  • Prognosis
  • Risk Factors
  • Sulfonylurea Compounds / adverse effects*
  • Sulfonylurea Compounds / therapeutic use

Substances

  • Hypoglycemic Agents
  • KATP Channels
  • Potassium Channel Blockers
  • Sulfonylurea Compounds