Cardiovascular disease (CVD) accounts for most deaths in patients with diabetes. The most common starting treatment for diabetes is either metformin or sulfonylureas. A new study reveals that, compared with metformin use, sulfonylurea use is associated with a 21 percent greater risk of hospitalization for heart attack or stroke, as well as death from any cause. This translates into an excess of approximately 2.2 CVD events or deaths for every 1,000 person who use sulfonylurea medications for 1 year.
The study does not clarify whether the increase in CVD risk is due to harm from sulfonylureas, benefit from metformin, or both. A team of researchers from Vanderbilt University studied 253,690 veterans aged 18 years or older (mostly white men) who received Veterans Health Administration care and medication (metformin or sulfonylurea) for their diabetes treatment.
The researchers believe that their observations support the use of metformin for first-line diabetes therapy and strengthen the evidence about the cardiovascular advantages of metformin compared with sulfonylureas. This study was supported in part by AHRQ (Contract No. 290-05-0042).
See "Comparative effectiveness of sulfonylurea and metformin immunotherapy on cardiovascular events in type 2 diabetes mellitus. A cohort study," by Christianne L. Roumie, M.D., Adriana M. Hung, M.D., Robert A. Greevy, Ph.D., and others in the November 2012 Annals of Internal Medicine 157, pp. 601-610.