Mayo Clinic researchers helped clarify a growing concern about the link between diabetes treatments and heart attack with the first large study showing that sulfonylureas do not reduce diabetic patients’ heart attack survival rates.
Second-generation sulfonylureas — known collectively as SU2 — include glimepiride (Amaryl), glipizide (Glucotrol, Glucotrol XL), and glyburide (DiaBeta, Micronase, Glynase).
The prevalence of diabetes mellitus is growing rapidly, and physicians need evidence for their treatment recommendations. Worldwide, the number of diabetics is projected to more than double in three decades, from 171 million in 2000 to 366 million in 2030.(2) Many patients with diabetes are at increased risk for heart failure. This complicates their treatment, and has raised concern in recent years among some physicians that SU2s may impair the heart’s ability to withstand stress, thus reducing patients’ ability to survive heart attacks, says Veronique Roger, M.D., M.P.H., the Mayo cardiologist and epidemiologist who led the study.
The Mayo study is the first to use a broad population of community members to extract information about the impact of various diabetes treatments on patients’ health after heart attack. The Mayo group evaluated the outcome of heart attack in two groups: people who had diabetes and those who did not. Group members were similar in terms of age, gender and lifestyle habits such as smoking. In the diabetes group, researchers tracked patient outcome after heart attack in patients taking three different treatment approaches to lowering blood sugar: SU2 drugs, insulin, diet.
“These data do not support the concern among some physicians of an adverse impact of SU2 on survival after a heart attack,” Dr. Roger says. “These results provide clinical guidance for physicians faced with managing a growing number of diabetic patients. Our study is also important because it underscores the potential role of community-based studies for helping provide evidence to clarify treatment strategies and improve care of patients.”
Using a specialized patient-records database maintained since 1936, researchers identified all heart attacks that occurred in Olmsted County, Minn., where Mayo Clinic is based, between 1979 and 2002. They identified 2,732 heart attack patients, with an average age of 70; 56 percent were women. Of the heart attack group, 486 (18 percent) also had diabetes mellitus. The diabetes patients were split into three groups and treated with SU2 drugs, insulin, or diet alone.
These results were presented at he American Heart Association’s Scientific Sessions 2007 in Orlando, Fla.
Knowledge of PAD is poor: Although peripheral arterial disease (PAD) is associated with decreased functional status, diminished quality of life, amputation, myocardial infarction, stroke, and death, the public knowledge of this condition is poor at best. A cross-sectional, population-based telephone survey of a nationally representative sample of 2501 adults ≥50 years of age found that: 26% of respondents expressed familiarity with PAD, a rate significantly lower than that for any other cardiovascular disease or atherosclerosis risk factor. Half of these individuals were not aware that diabetes and smoking increase the risk for PAD; 1 in 4 knew that PAD is associated with increased risk of heart attack and stroke; and only 14% were aware that PAD could lead to amputation. It was concluded that “The public is poorly informed about PAD, with major knowledge gaps regarding the definition of PAD, risk factors that lead to PAD, and associated limb symptoms and amputation risk. The public is not aware that PAD imposes a high short-term risk of heart attack, stroke, and death.
Circulation. 2007;116:2086-2094 October 23, 2007 .