COPENHAGEN — Newer-generation sulfonylureas appear to be associated with lower post-MI mortality in diabetic patients than are the older-generation agents, Dr. Henriette Thisted reported at the annual meeting of the European Association for the Study of Diabetes.
Earlier this year, Dr. Thisted and her associates published preliminary findings from a regional Danish hospital database, in which they found a lower rate of MI among patients using gliclazide and glimepiride, compared with those using other sulfonylureas, and a trend toward lower 30-day post-MI mortality among users of gliclazide, compared with users of other sulfonylureas (Am. J. Ther. 2006;13:134–40).
They have now expanded the study nationwide to include 72,913 first-time admissions for MI during 1996–2004 from the Danish National Patient Registry. From a national prescription database, 3,992 patients were identified as sulfonylurea users, including 2,554 taking the “old” sulfonylureas glibenclamide, glipizide, or tolbutamide and 1,438 users of the “new” agents gliclazide or glimepiride.
Not surprisingly, users of older sulfonylureas were older (73.3 vs. 71.6 years) and had a longer duration of diabetes (14.4% vs. 10.6% had been diagnosed for more than 10 years). They also tended to have more comorbidities, said Dr. Thisted of the department of clinical epidemiology at Aarhus (Denmark) University Hospital.
At 30 days following MI, 24.1% of the old sulfonylurea users had died, compared with 17.9% of the new-agent user group. After adjustment for age, sex, socioeconomic status, diabetes duration, comorbidity index, discharge diagnoses, and use of relevant medications, the new sulfonylurea users still had a 23% lower 30-day mortality rate than the old-agent users, Dr. Thisted reported.
This apparent advantage in 30-day mortality with new sulfonylureas was also evident during the entire follow-up period, with a mean of 1.68 years: The adjusted mortality rate ratio was 0.78, or a 22% lower risk of death post MI.