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Adverse cardiovascular events during treatment with glyburide (glibenclamide) or gliclazide in a high-risk population.
MedLine Citation:
PMID:  22913620     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Aims:  Sulphonylureas promote insulin release by inhibiting pancreatic potassium channels. Older sulphonylureas such as glyburide (glibenclamide), but not newer ones such as gliclazide, antagonize similar channels in myocardium, interfering with the protective effects of ischaemic preconditioning. Whether this imparts a higher risk of adverse cardiac events is unknown. Methods:  We conducted a population-based cohort study of patients aged 66 years and older who were hospitalized for acute myocardial infarction or who underwent percutaneous coronary intervention between 1 April 2007 and 31 March 2010 while receiving either glyburide or gliclazide. We used a high-dimensional propensity score matching process to ensure similarity of glyburide- and gliclazide-treated patients. The primary outcome was a composite of death or hospitalization for myocardial infarction or heart failure. Results:  During the 2-year study period, we matched 1690 patients treated with glyburide to 984 patients treated with gliclazide at the time of hospitalization for acute myocardial infarction or percutaneous coronary intervention. We found no difference in the risk of the composite outcome among patients receiving glyburide (adjusted hazard ratio 1.01; 95% CI 0.86-1.18). We found similar results in secondary analyses of each outcome individually, and in two supplementary analyses (haemorrhage and pneumonia) in which we anticipated no difference between the two patient groups. Conclusions:  Among older patients hospitalized for acute myocardial infarction or percutaneous coronary intervention, treatment with glyburide is not associated with an increased risk of future adverse cardiovascular events relative to gliclazide, suggesting that the effect of glyburide on ischaemic preconditioning is of little clinical relevance. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.
Authors:
D N Juurlink; T Gomes; B R Shah; M M Mamdani
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-22
Journal Detail:
Title:  Diabetic medicine : a journal of the British Diabetic Association     Volume:  -     ISSN:  1464-5491     ISO Abbreviation:  Diabet. Med.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8500858     Medline TA:  Diabet Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.
Affiliation:
The Sunnybrook Research Institute, Toronto, ON, Canada Departments of Medicine, Toronto, ON, Canada Departments of Pediatrics and Toronto, ON, Canada Departments of Health Policy, Management and Evaluation at the University of Toronto, Toronto, ON, Canada The Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Department of Pharmacy at the University of Toronto The Li Ka Shing Knowledge Institute, Toronto, ON, Canada.
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