Key result
Sulphonylurea use was associated with a significantly higher risk of incident atrial fibrillation (HR 2.89) and stroke (HR 3.23) compared to metformin in patients with type 2 diabetes mellitus.
Why the study?
To compare rates of incident AF, stroke, cardiovascular mortality, and all-cause mortality between metformin and sulphonylurea users with type 2 diabetes mellitus.
Does sulphonylurea monotherapy increase the risk of new-onset atrial fibrillation and stroke in patients with type 2 diabetes mellitus compared to metformin monotherapy?
Cohort (n=108,684)
Does sulphonylurea monotherapy increase the risk of new-onset atrial fibrillation and stroke in patients with type 2 diabetes mellitus compared to metformin monotherapy?
Hazard Ratio: 2.89 (95% CI 2.75–2.77)
Absolute Event Rate: 15.54% vs 5.44%
p-value: p=<0.0001
In patients with type 2 diabetes, sulphonylurea monotherapy is associated with significantly higher risks of incident atrial fibrillation, stroke, and mortality compared to metformin.
Background To compare the rates of incident atrial fibrillation (AF), stroke, cardiovascular mortality, and all-cause mortality between metformin and sulphonylurea users in type 2 diabetes mellitus. Methods This was a retrospective population-based cohort study of type 2 diabetes mellitus patients receiving either sulphonylurea or metformin monotherapy between January 1 st , 2000 and December 31 st , 2019. The primary outcome was new-onset AF or stroke. Secondary outcomes were cardiovascular, non-cardiovascular and all-cause mortality. Propensity score matching (1:2 ratio) between sulphonylurea and metformin users was performed, based on demographics, CHA-DS-VASc score, Charlson comorbidity index, past comorbidities, and medication use. Cox regression was used to identify significant risk factors. Competing risk analysis was conducted using cause-specific and subdistribution hazard models. Sensitivity analysis using propensity score stratification, high dimensional propensity score and inverse probability of treatment weighting were conducted. Results A total of 36228 sulphonylurea users and 72456 metformin users were included in the propensity score-matched cohort. Multivariable Cox regression showed that sulphonylurea users had higher risks of incident AF (hazard ratio [HR]: 2.89, 95% confidence interval [CI]: 2.75-2.77; P<0.0001), stroke (HR: 3.23, 95% CI: 3.01-3.45; P<0.0001), cardiovascular mortality (HR: 3.60, 95% CI: 2.62-4.81; P<0.0001), and all-cause mortality (HR: 4.35, 95% CI: 3.16-4.75; P<0.0001) compared to metformin users. Similarly significant results were observed using cause-specific and subdistribution hazard models. Sensitvity analysis using other propensity score techniques also yielded higher risks in sulphonylurea users. Conclusions Sulphonylurea use was associated with higher risks of incident AF, stroke, cardiovascular mortality and all-cause mortality compared to metformin.
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Zhou et al. (2021) conducted a cohort in Type 2 diabetes mellitus (n=108,684). Sulphonylurea vs. Metformin was evaluated on New-onset atrial fibrillation (HR 2.89, 95% CI 2.75-2.77, p=<0.0001). Sulphonylurea use was associated with a significantly higher risk of incident atrial fibrillation (HR 2.89) and stroke (HR 3.23) compared to metformin in patients with type 2 diabetes mellitus.
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