Glimepiride: an old antidiabetic medication with potential as a new cardiovascular therapeutic?

We read with great interest the recently published work by He et al.,1 which demonstrated the potential cardiovascular benefits of glimepiride in patients with type 2 diabetes (T2D) and chronic heart failure (HF). The authors followed 21 451 inpatients with T2D and chronic HF (left ventricular ejection fraction <50%; elevated level of N-terminal pro-brain natriuretic peptide >125 pg/mL; and/or left ventricular diameter ≥50 mm), and found that those who continued on glimepiride after discharge experienced fewer HF rehospitalisations or emergency admissions [hazard ratio (HR) 0.42; 95% confidence interval (95%CI) 0.36–0.50], and fewer cardiovascular (HR 0.34; 95%CI 0.24–0.48) and all-cause mortalities (HR 0.47; 95%CI 0.35–0.63).1 For many researchers and clinicians, this result is surprising and intriguing. Even sodium-glucose cotransporter 2 (SGLT2) inhibitors reduced HF rehospitalisation by ≤30% in T2D patients at risk of cardiovascular events, and the effect on all-cause mortality was inconsistent in recent large-scale randomized cardiovascular outcome trials,2 although interventional and observational studies cannot be simply compared.