Hypoglycemia associated with cardiovascular risk among sulfonylurea users
medwireNews: Patients with type 2 diabetes who experience hypoglycemia during sulfonylurea treatment are at greater risk for cardiovascular events than those who do not experience hypoglycemia, results of a US study suggest.
In an analysis of nationwide electronic health records from 143,635 sulfonylurea users, the researchers found that 7123 incident and 13,259 total hypoglycemic events occurred from 2009 to 2014. Of these 3063 incident and 6989 of the total hypoglycemic events were serious, defined as those with evidence of medical intervention or specifically described as severe.
Over the follow-up period, there were 5669, 7017, and 14,109 cases of acute myocardial infarction (AMI), stroke, and congestive heart failure (CHF), respectively, with corresponding incidence rates of 1.53, 1.92, and 4.26 per 100 person–years.
Patients who experienced one, two, and three hypoglycemic events had a 1.44-, 1.50-, and 1.57-fold increased risk for stroke, respectively, and a 1.45-, 1.49-, and 1.71-fold increased risk for CHF, and these associations were stronger for serious relative to nonserious hypoglycemia.
The association between increasing frequency of hypoglycemia and risk for stroke and CHF is “suggestive of a dose response relationship,” report the authors in Diabetes, Obesity and Metabolism.
However, while hypoglycemia was also associated with an increased risk for AMI, with a stronger association for serious versus nonserious hypoglycemia, the risk was “elevated and uniform across categories of hypoglycaemia frequency.”
These associations “may be a contributing factor to the lack of cardio-protective results for [sulfonylurea] medicines despite their antihyperglycemic effect,” note Anthony Nunes (Optum Epidemiology, Boston, Massachusetts) and study co-authors.
The team also identified an association between weight change and cardiovascular disease events among sulfonylurea users, with patients experiencing weight loss or weight gain having an increased risk for stroke, CHF, and AMI compared with those who maintained a stable weight.
These findings suggest that “the magnitude of weight gain and the incidence of hypoglycaemia that occurs […] are risk factors for cardiovascular outcomes” among sulfonylurea-treated patients, say the researchers.
They caution that “[t]he assessment of hypoglycaemia occurrence in real world settings is complicated by detection and documentation limitations,” meaning that some hypoglycemic events may have been missed in the study.
Nevertheless, they conclude: “If the observed associations are causal, then the clinical implication would be increased attention towards the prevention of hypoglycaemia, recognizing there are clinical situations where intensive glucose control remains the preferable standard of care.”
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