Giuseppe Biondi-Zoccai1, Annamaria Pinto, Francesco Versaci, Enrica Procaccini, Giandomenico Neri, Giorgio Sesti, Luigi Uccioli, Maurizio Vetere, Mariangela Peruzzi, Francesco Nudi. 1. *Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; †Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy; ‡Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy; §Ostia Radiologica, Rome, Italy; ¶Department of Cardiovascular Disease, Ospedale A. Cardarelli, Campobasso, Italy; ‖Department of Cardiovascular Disease, Ospedale F. Veneziale, Isernia, Italy; **Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy; ††Diabetic Foot Unit, Tor Vergata University of Rome, Rome, Italy; and ‡‡Etisan, Rome, Italy.
Abstract
BACKGROUND: Hypoglycemic agents differ in mechanism, efficacy, and profile. However, there is uncertainty on their impact on myocardial perfusion. We thus aimed to investigate whether individuals with type 2 diabetes mellitus treated with different drug classes exhibit different perfusion patterns at myocardial perfusion scintigraphy (MPS). METHODS AND RESULTS: We queried our administrative database for patients with diabetes mellitus without prior or recent myocardial infarction. The primary objective was to compare the severity and extent of ischemia at MPS, distinguishing patients according to management strategy. A total of 7592 patients were included [2336 (31%) on diet, 3611 (48%) on metformin, 749 (10%) on sulfonylureas, 449 (6%) on metformin plus sulfonylureas, 447 (6%) on metformin plus insulin]. Unadjusted analyses and analyses adjusting for baseline features suggested that sulfonylureas alone or in combination were associated with more severe ischemia than nonsulfonylurea regimens (P < 0.05), whereas combination regimens including metformin were associated with more extensive myocardial ischemia than the other regimens (P < 0.05 for both). However, no significant difference disfavoring either metformin or sulfonylurea regimens persisted after multivariable adjustment for baseline, stress, and angiographic characteristics (all P > 0.05). CONCLUSION: Several significant differences in baseline, stress, and scintigraphic features appear evident in patients with diabetes mellitus receiving different hypoglycemic agents or regimens.
BACKGROUND: Hypoglycemic agents differ in mechanism, efficacy, and profile. However, there is uncertainty on their impact on myocardial perfusion. We thus aimed to investigate whether individuals with type 2 diabetes mellitus treated with different drug classes exhibit different perfusion patterns at myocardial perfusion scintigraphy (MPS). METHODS AND RESULTS: We queried our administrative database for patients with diabetes mellitus without prior or recent myocardial infarction. The primary objective was to compare the severity and extent of ischemia at MPS, distinguishing patients according to management strategy. A total of 7592 patients were included [2336 (31%) on diet, 3611 (48%) on metformin, 749 (10%) on sulfonylureas, 449 (6%) on metformin plus sulfonylureas, 447 (6%) on metformin plus insulin]. Unadjusted analyses and analyses adjusting for baseline features suggested that sulfonylureas alone or in combination were associated with more severe ischemia than nonsulfonylurea regimens (P < 0.05), whereas combination regimens including metformin were associated with more extensive myocardial ischemia than the other regimens (P < 0.05 for both). However, no significant difference disfavoring either metformin or sulfonylurea regimens persisted after multivariable adjustment for baseline, stress, and angiographic characteristics (all P > 0.05). CONCLUSION: Several significant differences in baseline, stress, and scintigraphic features appear evident in patients with diabetes mellitus receiving different hypoglycemic agents or regimens.
Authors: Jake Russell; Eugene F Du Toit; Jason N Peart; Hemal H Patel; John P Headrick Journal: Cardiovasc Diabetol Date: 2017-12-04 Impact factor: 9.951