Thursday, September 2, 2010

sulfonureas are ok

J Clin Endocrinol Metab. 2010 Aug 11. [Epub ahead of print]

Impact of Type of Preadmission Sulfonylureas on Mortality and Cardiovascular Outcomes in Diabetic Patients with Acute Myocardial Infarction.

Zeller M, Danchin N, Simon D, Vahanian A, Lorgis L, Cottin Y, Berland J, Gueret P, Wyart P, Deturck R, Tabone X, Machecourt J, Leclercq F, Drouet E, Mulak G, Bataille V, Cambou JP, Ferrieres J, Simon T; for the French Registry of Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction investigators.

Laboratory of Experimental Cardiovascular Pathophysiology and Pharmacology (M.Z.), institut Fédératif de Recherche Santé-Sciences et Techniques de l'Information et de la Communication, 21000 Dijon, France; Department of Cardiology (N.D.), Hôpital Européen Georges Pompidou Université René-Descartes, 75014 Paris, France; Department of Diabetology (D.S.), Hôpital Pitié-Salpêtrière, 75634 Paris, France; Department of Cardiology (A.V.), Centre Hospitalier Universitaire Bichat, 75018 Paris, France; Department of Cardiology (L.L., Y.C.), Centre Hospitalier Universitaire, 21034 Dijon, France; Clinique St. Hilaire (J.B.), 76000 Rouen, France; Department of Cardiology (P.G.), Centre Hospitalier Universitaire Mondor, 94010 Créteil, France; Department of Cardiology (P.W.), Centre Hospitalier Intercommunal 94195 Villeneuve St. Georges, France; Department of Cardiology (R.D.), Centre Hospitalier Général, 62300 Lens, France; Centre Hospitalier Général (X.T.), 18000 Bourges, France; Centre Hospitalier Universitaire (J.M.), 38100 Grenoble, France; Department of Cardiology (F.L.), Centre Hospitalier Universitaire, 34295 Montpellier, France; Société Française de Cardiologie (E.D., G.M.), 75012 Paris, France; Department of Cardiology (V.B., J.-P.C., J.F.), Centre Hospitalier Universitaire, 31059 Toulouse, France; and Department of Pharmacology (T.S.), Assistance Publique-Hôpitaux de Paris-Hôpital Saint-Antoine-Unité de Recherche Clinique Est, Université Pierre et Marie Curie, 75005 Paris-VI, France.


Background: The impact of antidiabetic medications on clinical outcomes in patients developing acute myocardial infarction (MI) is controversial. We sought to determine whether in-hospital outcomes in patients who were on sulfonylureas (SUs) when they developed their MIs differed from that of diabetic patients not receiving SUs and whether clinical outcomes were related to the pancreatic cells specificity of SUs. Methods and Results: We analyzed the outcomes of the 1310 diabetic patients included in the nationwide French Registry of Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction in 2005. Medications used before the acute episode were recorded. In-hospital complications were analyzed according to prior antidiabetic treatment. Mortality was lower in patients previously treated with SUs (3.9%) vs. those on other oral medications (6.4%), insulin (9.4%), or no medication (8.4%) (P = 0.014). Among SU-treated patients, in-hospital mortality was lower in patients receiving pancreatic cells-specific SUs (gliclazide or glimepiride) (2.7%), compared with glibenclamide (7.5%) (P = 0.019). Arrhythmias and ischemic complications were also less frequent in patients receiving gliclazide/glimepiride. The lower risk in patients receiving gliclazide/glimepiride vs. glibenclamide persisted after multivariate adjustment (odds ratio 0.15; 95% confidence interval 0.04-0.56) and in propensity score-matched cohorts. Conclusion: In this nationwide registry of patients hospitalized for acute MI, no hazard was associated with the use of SUs before the acute episode. In addition, patients previously receiving gliclazide/glimepiride had improved in-hospital outcomes, compared with those on glibenclamide.

Dr. Wei-An Andy Lee
Clinical Endocrinologist
Assistant Professor of Clinical Medicine
Keck School of Medicine
University of Southern California

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