[Effect of antidiabetic treatment in ischemic heart diseases]

In a retrospective study of 962 diabetic (male: 441, female: 521) patients in the Diabetic Outpatient Clinic of the National Institute of Cardiology between 1st November 1967 and 31st October 1988 the survival time of diabetics treated with first generation sulphonylureas was considerably less after the first attack of angina pectoris or acute myocardial infarction compared with that of individuals controlled with regime alone or being on glibenclamide or insulin treatments. The systolic blood pressure proved to be higher in diabetics treated with first generation sulphonylureas. During the observation, among the 183 patients on insulin- as well as in the 262 individuals on first and 230 on second generation sulphonylurea treatments, and in the 287 diabetics controlled with regime alone, 547 (male: 241, female: 306) patients died, 403 of them due to cardiovascular and renal failures. Between the diabetics suffering from ischaemic heart diseases no difference could be detected relating the risk factors except the higher systolic blood pressure. The alterations in the cardiovascular states during the survey, the improvement of therapeutical interventions, the alterations in the carbohydrate and lipid metabolism are not supposed to be involved in the shorter survival time of diabetics treated with first generation sulphonylureas. The shorter survival time might be explained by the arrhythmogenic activity of first generation sulphonylureas described in earlier studies. On this basis we are tempted to draw the conclusion that second generation sulphonylureas must be selected in the diabetes care, if the metabolic state could not be normalized by diet and regime only.