Are users of sulphonylureas at the time of an acute coronary syndrome at risk of poorer outcomes?
Article first published online: 3 JUN 2013
© 2013 John Wiley & Sons Ltd
Diabetes, Obesity and Metabolism
Volume 15, Issue 11, pages 1022–1028, November 2013
How to Cite
Nagendran, J., Oudit, G. Y., Bakal, J. A., Light, P. E., Dyck, J. R. B. and McAlister, F. A. (2013), Are users of sulphonylureas at the time of an acute coronary syndrome at risk of poorer outcomes?. Diabetes, Obesity and Metabolism, 15: 1022–1028. doi: 10.1111/dom.12126
- Issue published online: 7 OCT 2013
- Article first published online: 3 JUN 2013
- Accepted manuscript online: 13 MAY 2013 11:29AM EST
- Manuscript Accepted: 7 MAY 2013
- Manuscript Revised: 24 MAR 2013
- Manuscript Received: 19 MAR 2013
- Mazankowski Alberta Heart Institute
- Alberta Innovates Health Solutions (AiHS)
- Canadian Diabetes Association to Jeevan Nagendran
- AiHS funded Alberta HEART program
- cardiovascular disease;
- diabetes mellitus;
Adenosine triphosphate sensitive potassium (KATP) channel activity is cardioprotective during ischaemia. One of the purported mechanisms for sulphonylurea adverse effects is through inhibition of these channels. The purpose of this study is to examine whether patients using KATP channel inhibitors at the time of an acute coronary syndrome are at greater risk of death or heart failure (HF) than those not exposed.
Using linked administrative databases we identified all adults who had an acute coronary syndrome between April 2002 and October 2006 (n = 21 023).
Within 30 days of acute coronary syndrome, 5.3% of our cohort died and 15.6% were diagnosed with HF. Individuals with diabetes exhibited significantly higher risk of death (adjusted OR: 1.20, 95% CI: 1.03–1.40) and death or HF (aOR: 1.73, 95% CI: 1.59–1.89) than individuals without diabetes. However, there was no significantly increased risk of death (aOR: 1.00, 95% CI: 0.76–1.33) or death/HF (aOR: 1.06, 95% CI: 0.89–1.26) in patients exposed to KATP channel inhibitors versus patients not exposed to KATP channel inhibitors prior to their acute coronary syndrome.
Diabetes is associated with an increased risk of death or HF within 30 days of an acute coronary syndrome. However, we did not find any excess risk of death or HF associated with use of KATP channel inhibitors at the time of an acute coronary syndrome, raising doubts about the hypothesis that sulphonylureas inhibit the cardioprotective effects of myocardial KATP channels.