Jiandong Zhou1, Guoming Zhang2, Carlin Chang3, Oscar Hou In Chou3,4, Sharen Lee4, Keith Sai Kit Leung5,6, Wing Tak Wong7, Tong Liu8, Abraham Ka Chung Wai6, Shuk Han Cheng9, Qingpeng Zhang10, Gary Tse11,12. 1. Nuffield Department of Medicine, University of Oxford, Oxford, UK. 2. Emergency Department, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China. 3. Department of Medicine, University of Hong Kong, Pokfulam, Hong Kong, China. 4. Diabetes Research Unit, Cardiovascular Analytics Group, UK-China Collaboration, Hong Kong, China. 5. Aston Medical School, Aston University, Birmingham, UK. 6. Emergency Medicine Unit, Li Ka Shing, Faculty of Medicine, The University of Hong Kong, Hong Kong, China. 7. School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China. 8. Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China. 9. School of Biomedical Sciences, City University of Hong Kong, Hong Kong, China. 10. School of Data Science, City University of Hong Kong, Kowloon City, Hong Kong, China. qingpeng.zhang@cityu.edu.hk. 11. Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China. gary.tse@kmms.ac.uk. 12. Kent and Medway Medical School, Canterbury, UK. gary.tse@kmms.ac.uk.
Abstract
AIMS: To gain insights on the cardiovascular effects of metformin and sulphonylurea, the present study compares the rates of incident atrial fibrillation, stroke, cardiovascular mortality and all-cause mortality between metformin and sulphonylurea users in type 2 diabetes mellitus. METHODS: This was a retrospective population-based cohort study of type 2 diabetes mellitus patients receiving either sulphonylurea or metformin monotherapy between January 1, 2000, and December 31, 2019. The primary outcome was new-onset AF or stroke. Secondary outcomes were cardiovascular, non-cardiovascular and all-cause mortality. Propensity score matching (1:2 ratio) between sulphonylurea and metformin users was performed, based on demographics, CHA-DS-VASc score, past comorbidities and medication use. Cox regression was used to identify significant risk factors. Competing risk analysis was conducted using cause-specific and subdistribution hazard models. Sensitivity analyses using propensity score stratification, high-dimensional propensity score and inverse probability of treatment weighting were conducted. Subgroup analyses were conducted for age and gender in the matched cohort. RESULTS: A total of 36,228 sulphonylurea users and 72,456 metformin users were included in the propensity score-matched cohort. Multivariable Cox regression showed that sulphonylurea users had higher risks of incident AF (hazard ratio [HR]: 2.89, 95% confidence interval [CI]: 2.75-3.77; P < 0.0001), stroke (HR: 3.23, 95% CI: 3.01-3.45; P < 0.0001), cardiovascular mortality (HR: 3.60, 95% CI: 2.62-4.81; P < 0.0001) and all-cause mortality (HR: 4.35, 95% CI: 3.16-4.75; P < 0.0001) compared to metformin users. Similarly, significant results were observed using cause-specific and subdistribution hazard models. Sensitivity analysis using techniques based on the propensity score also yielded similar results. CONCLUSIONS: Sulphonylurea use was associated with higher risks of incident AF, stroke, cardiovascular mortality and all-cause mortality compared to metformin. Males and patients older than 65 years with sulphonylurea use were exposed to the highest risks.
AIMS: To gain insights on the cardiovascular effects of metformin and sulphonylurea, the present study compares the rates of incident atrial fibrillation, stroke, cardiovascular mortality and all-cause mortality between metformin and sulphonylurea users in type 2 diabetes mellitus. METHODS: This was a retrospective population-based cohort study of type 2 diabetes mellitus patients receiving either sulphonylurea or metformin monotherapy between January 1, 2000, and December 31, 2019. The primary outcome was new-onset AF or stroke. Secondary outcomes were cardiovascular, non-cardiovascular and all-cause mortality. Propensity score matching (1:2 ratio) between sulphonylurea and metformin users was performed, based on demographics, CHA-DS-VASc score, past comorbidities and medication use. Cox regression was used to identify significant risk factors. Competing risk analysis was conducted using cause-specific and subdistribution hazard models. Sensitivity analyses using propensity score stratification, high-dimensional propensity score and inverse probability of treatment weighting were conducted. Subgroup analyses were conducted for age and gender in the matched cohort. RESULTS: A total of 36,228 sulphonylurea users and 72,456 metformin users were included in the propensity score-matched cohort. Multivariable Cox regression showed that sulphonylurea users had higher risks of incident AF (hazard ratio [HR]: 2.89, 95% confidence interval [CI]: 2.75-3.77; P < 0.0001), stroke (HR: 3.23, 95% CI: 3.01-3.45; P < 0.0001), cardiovascular mortality (HR: 3.60, 95% CI: 2.62-4.81; P < 0.0001) and all-cause mortality (HR: 4.35, 95% CI: 3.16-4.75; P < 0.0001) compared to metformin users. Similarly, significant results were observed using cause-specific and subdistribution hazard models. Sensitivity analysis using techniques based on the propensity score also yielded similar results. CONCLUSIONS: Sulphonylurea use was associated with higher risks of incident AF, stroke, cardiovascular mortality and all-cause mortality compared to metformin. Males and patients older than 65 years with sulphonylurea use were exposed to the highest risks.
Authors: K Ogurtsova; J D da Rocha Fernandes; Y Huang; U Linnenkamp; L Guariguata; N H Cho; D Cavan; J E Shaw; L E Makaroff Journal: Diabetes Res Clin Pract Date: 2017-03-31 Impact factor: 5.602
Authors: Robert J Huggett; Eleanor M Scott; Stephen G Gilbey; John B Stoker; Alan F Mackintosh; David A S G Mary Journal: Circulation Date: 2003-12-15 Impact factor: 29.690
Authors: Raymond Ngai Chiu Chan; Teddy Tai Loy Lee; Oscar Hou In Chou; Jenny So; Cheuk To Chung; Edward Christopher Dee; Kenrick Ng; Pias Tang; Leonardo Roever; Tong Liu; Wing Tak Wong; Gary Tse; Sharen Lee Journal: J Endocr Soc Date: 2022-09-05
Authors: Jiandong Zhou; Oscar Hou In Chou; Ka Hei Gabriel Wong; Sharen Lee; Keith Sai Kit Leung; Tong Liu; Bernard Man Yung Cheung; Ian Chi Kei Wong; Gary Tse; Qingpeng Zhang Journal: Front Cardiovasc Med Date: 2022-07-08