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The risk of heart failure in patients with type 2 diabetes treated with oral agent monotherapy

Finlay A McAlister1, Dean T Eurich, Sumit R Majumdar

  • 1Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Finlay.McAlister@ualberta.ca

European Journal of Heart Failure
|June 24, 2008
PubMed
Abstract

Insights

High-dose sulfonylurea use in diabetic patients increases heart failure (HF) risk compared to metformin. Clinicians should consider this when prescribing sulfonylureas, especially for patients with or at risk of HF.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Diabetes mellitus is a prevalent condition associated with cardiovascular complications.
  • Oral antidiabetic drugs, including sulfonylureas and metformin, are commonly prescribed for type 2 diabetes management.
  • Heart failure (HF) is a significant comorbidity in diabetic populations.

Purpose of the Study:

  • To investigate the association between the use of sulfonylurea or metformin and the risk of developing heart failure (HF) in patients with diabetes.
  • To compare the HF risk between patients treated with sulfonylurea monotherapy versus metformin monotherapy.

Main Methods:

  • Retrospective cohort study design.
  • Inclusion of adult diabetic patients newly treated with oral antidiabetic drugs in Saskatchewan, Canada (1991-1999).
  • Follow-up to assess incident HF development.

Main Results:

  • A total of 5,631 diabetic subjects were analyzed.
  • The incidence of HF was higher in sulfonylurea users (4.4 cases/100 patient years) compared to metformin users (3.3 cases/100 patient years).
  • High-dose sulfonylurea use was associated with a significantly increased risk of HF (adjusted HR 1.24) compared to high-dose metformin, and also compared to low-dose sulfonylureas (HR 1.38).

Conclusions:

  • Higher doses of sulfonylurea are linked to an elevated risk of developing heart failure.
  • Healthcare providers should exercise caution when prescribing high-dose sulfonylurea therapy to diabetic patients, particularly those with existing or high risk of HF.

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