Risk of acute coronary events associated with glyburide compared with gliclazide use in patients with type 2 diabetes: a nested case–control study
Version of Record online: 19 JUL 2013
© 2013 John Wiley & Sons Ltd
Diabetes, Obesity and Metabolism
Volume 16, Issue 1, pages 22–29, January 2014
How to Cite
Abdelmoneim, A. S., Eurich, D. T., Gamble, J. M., Johnson, J. A., Seubert, J. M., Qiu, W. and Simpson, S. H. (2014), Risk of acute coronary events associated with glyburide compared with gliclazide use in patients with type 2 diabetes: a nested case–control study. Diabetes, Obesity and Metabolism, 16: 22–29. doi: 10.1111/dom.12173
- Issue online: 17 DEC 2013
- Version of Record online: 19 JUL 2013
- Accepted manuscript online: 26 JUN 2013 02:01PM EST
- Manuscript Accepted: 19 JUN 2013
- Manuscript Revised: 14 MAY 2013
- Manuscript Received: 5 MAR 2013
- Canadian Diabetes Association. Grant Number: OG-2-09-2693-SS
- Canadian Institutes for Health Research. Grant Number: OGT-88588
- acute coronary syndrome;
- ischaemic conditioning;
- nested case–control study;
Sulfonylureas might increase the risk of adverse cardiovascular events; however, emerging evidence suggests there may be important differences amongst these drugs. Some, like glyburide, inhibit KATP channels in the heart and pancreas, while others, like gliclazide, are more likely to selectively inhibit KATP channels in the pancreas. We hypothesized that the risk of acute coronary syndrome (ACS) events would be higher in patients using glyburide compared with gliclazide.
This nested case–control study used administrative health data from Alberta, Canada. New users of glyburide or gliclazide aged ≥66 years between 1998 and 2010 were included. Cases were individuals with an ACS-related hospitalization or death. Up to four controls were matched based on birth year, sex, cohort-entry year and follow-up time. Multivariable conditional logistic regression was used to estimate adjusted odds ratios (OR), controlling for baseline drug use and co-morbidities.
Our cohort included 7441 gliclazide and 13 884 glyburide users; 51.4% men, mean (s.d.) age 75.5 (6.6) years and mean (s.d.) duration of follow-up 5.5 (4.0) years. A total of 4239 patients had an ACS-related hospitalization or death and were matched to 16 723 controls. Compared with gliclazide use, glyburide use was associated with a higher risk (adjusted OR 1.14; 95% CI 1.06–1.23) of ACS-related hospitalization or death over 5.5 years (number needed to harm: 50).
In this observational study, glyburide use was associated with a 14% higher risk of ACS events compared with gliclazide use. Although the difference is small and probably to have implications at the population level rather than the individual patient or clinician, any causal inferences regarding sulfonylurea use and adverse cardiovascular risk should be tested in a large-scale randomized controlled trial.