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No Association Between Sulfonylurea Use and Cardiovascular Mortality

Sulfonylureas not associated with increased cardiovascular mortality, myocardial infarction and stroke in a meta-analysis of 47 randomized clinical trials…

Sulfonylureas are relatively inexpensive and are important therapeutic agents in type 2 diabetes management. However, they are not widely used due to safety concerns regarding hypoglycemia and weight gain. Furthermore, it has not been established whether sulfonylureas increase risk for cardiovascular mortality since there are many systematic reviews and meta-analysis showing conflicting results.

In a recent meta-analysis conducted by Dr. Dimitris and his team, the researchers sought to evaluate the safety of current sulfonylureas in total and cardiovascular mortality. The study was a systematic review, meta-analysis and trial of sequential analysis of 47 randomized clinical trials with at least 52 weeks of duration evaluating the safety and efficacy of any second and third generation of sulfonylureas (glyburide, glibenclamide, glicazide or glipizide) in treatment of type 2 diabetes.

Results showed a statistically insignificant data linking the use of sulfonylureas with cardiovascular mortality (odd ratio (OR) = 1.12, 95% C.I. 0.87 to 1.42; I2 = 12%, p = 0.30). Sulfonylureas were also not associated with increased risk for myocardial infarction or stroke with the (OR 0.92, 95% CI 0.76 – 1.12; I2 = 3% p = 0.42) and (OR 1.16, 95% CI 0.81 – 1.66; I2 = 30% p = 0.09), respectively.

The finding of this study suggests the safety and effective use of sulfonylureas in treatment of type 2 diabetes. First and second generation sulfonylureas are generally not associated with increased cardiovascular mortality. Glipizide was the only exception; researchers found an increase in risk of all-cause and cardiovascular mortality with glipizide.

Practice Pearls:

  • Sulfonylureas increase risk of hypoglycemia and weight gain.
  • Sulfonylureas were not associated with increased risk for myocardial infarction, stroke, or cardiovascular mortality.
  • Glipizide is the only sulfonylurea that increases risk for cardiovascular mortality.

Rados DV, Pinto LC, Remonti LR, et al. Sulfonylureas are not associated with increased mortality: Meta-analysis and trial sequential analysis of randomized clinical trials. American Diabetes Association 2015 Scientific Sessions; June 6, 2015; Boston, MA. Abstract 16-OR.