Sulfonylureas in type 2 diabetes did not significantly affect overall MACE (OR 1.08; 95% CI 0.86-1.36; p=0.52) but were associated with increased mortality and a higher risk of stroke.
Meta-Analysis
Does sulfonylurea therapy affect the risk of major cardiovascular events and mortality compared to non-sulfonylurea agents in patients with type 2 diabetes?
In patients with type 2 diabetes, sulfonylureas may be associated with an increased risk of mortality and stroke compared to non-sulfonylurea agents, highlighting the need for long-term cardiovascular outcomes trials.
Effect estimate: OR 1.08 (95% CI 0.86-1.36)
p-value: p=0.52
AIM: Cardiovascular safety of sulfonylurea has been questioned by some authors. This article aims at collecting all available data on this issue from randomized trials. METHODS: A meta-analysis was performed including all trials with a duration of at least 6 months, comparing a sulfonylurea with a non-sulfonylurea agent in type 2 diabetes. Major cardiovascular events (MACE) and mortality were retrieved and combined to calculate Mantel-Haenzel odds ratio (MH-OR). RESULTS: Of the 115 selected trials, 62 reported information on MACE, and 30 reported at least one event. MH-OR for sulfonylurea was 1.08 0.86-1.36, p = 0.52 (1.85 1.20-2.87, p = 0.005, in the five trials vs. DPP4 inhibitors, no significant differences vs. other comparators). The MH-OR for myocardial infarction and stroke was 0.88 0.75-1.04, p = 0.13 and 1.28 1.03-1.60, p = 0.026, respectively. Mortality was significantly increased with sulfonylureas (MH-OR: 1.22 1.01-1.49, p = 0.047). CONCLUSIONS: In type 2 diabetes, the use of sulfonylureas is associated with increased mortality and a higher risk of stroke, whereas the overall incidence of MACE appears to be unaffected. Significant differences in cardiovascular risk could be present in direct comparisons with specific classes of glucose-lowering agents, such as DPP4 inhibitors, but this hypothesis needs to be confirmed in long-term cardiovascular outcomes trials. The results of this meta-analysis need to be interpreted with caution, mainly because of limitations in trial quality and under-reporting of information on cardiovascular events and mortality. However, the cardiovascular safety of sulfonylureas cannot be considered established unless it is evaluated in long-term cardiovascular outcomes trials.
Monami et al. (Wed,) conducted a meta-analysis in type 2 diabetes. sulfonylurea vs. non-sulfonylurea agent was evaluated on Major cardiovascular events (MACE) (OR 1.08, 95% CI 0.86-1.36, p=0.52). Sulfonylureas in type 2 diabetes did not significantly affect overall MACE (OR 1.08; 95% CI 0.86-1.36; p=0.52) but were associated with increased mortality and a higher risk of stroke.
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