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Cardiac Abnormalities Associated with Sulfonylureas

Study adds further evidence to the proposed causal relationship between sulfonylureas and adverse cardiovascular events.

Studies with animal models have shown that sulfonylureas increase the size of myocardial infarction, but there is insufficient data to relate this finding to humans. Therefore, a study was performed to evaluate the association between sulfonylureas use and infarct size in diabetes patients with ST-elevation myocardial infarction (STEMI).

In this study, consecutive STEMI patients admitted between 2006 and 2011 were enrolled. Patients with T2DM were identified from this group and the maximum-recorded troponin 1 within the first 48 hours of chest pain onset was used as the primary endpoint to measure infarct size. Multivariable linear regression was used to assess the relationship between preadmission sulfonylurea use and maximum-recorded troponin 1. This was adjusted for patient demographics, CV risk factors, clinical data on admission, ischemia time, reperfusion therapy and preadmission drugs.

Researchers found that there were 560 STEMI patients with T2DM; average age of 63 years (standard deviation of 12.8 years), 395 males (70.5%), 216 received primary PCI (38.6%), and 211 received thrombolysis (37.7%). Furthermore, the maximum-recorded troponin 1 was higher in 146 sulfonylurea users compared to 414 non-sulfonylurea users (49.8 ng/mL vs. 39.9 ng/mL, respectively).

The authors claim that this study adds further evidence to the projected causal relationship between sulfonylureas and adverse cardiovascular events by discerning a significant difference in infarct size among type-2 diabetes patients presenting with ST-elevation myocardial infarction. Therefore, researchers believe that clinicians should consider this correlation when prescribing sulfonylureas to manage patients with T2DM.

Practice Pearls:

  • The use of sulfonylureas among T2DM with STEMI may increase the size of myocardial infarct.
  • Clinicians should consider the cardiovascular risks associated with sulfonylurea use among T2DM patients when prescribing any antidiabetics within this class
  • Further studies need to be performed to identify which sulfonylurea has the greatest cardiovascular risk among T2DM patients with STEMI

Abdelmoneum AS, et. Al. “Sulfonylurea use is associated with larger infarct size in patients with diabetes and ST-elevation myocardial infarction.” Int J Cardiol. 2015 Sep 1;202: 126-130.