Abstract 17706: Differences in Risk of Myocardial Infarction, Stroke or Cardiovascular Death According to Metformin in Different Dual Combinations in Patients with Diabetes Without Prior Myocardial Infarction; A Nationwide Study
Introduction: Metformin is the recommended state-of-the art first-line treatment in patients with type 2 diabetes, but the potential risk or benefit of dual combination of metformin with other glucose-lowering agents is largely unknown. Objectives: To analyze cardiovascular risk according to different dual combinations of glucose-lowering agents in diabetes patients without prior myocardial infarction.
Methods: All residents in Denmark aged over 20 years by January 1, 1997 without prior myocardial infarction and initiating dual combination with metformin during 1997 to 2006 were included and followed by individual-level-linkage of nationwide registers up till 9 years. The use of specific oral glucose-lowering drugs was identified by prescription claims. The risk of the combined endpoint of myocardial infarction, stroke and cardiovascular death was estimated by multivariable, time-dependent Cox proportional-hazard analyses, adjusted for age, gender, comorbidity, socioeconomic status, concomitant cardiovascular medication and previous treatment with glucose-lowering agents. Metformin combined with glimepiride was used as the reference.
Results: A total of 36,650 subjects were included: Myocardial infarction, stroke or cardiovascular death occurred in 3795 (%) during the study period. Metformin in dual combination with glibenclamide and glipizide was associated with increased risk of the combined endpoint (HR [95%CI]; 1.19 [1.04-1.38] and[95%CI]; 1.21 [1.03-1.43], respectively) compared to dual combination of metformin and glimepiride, whereas the risk was similar for treatment with dual combinations of metformin with glimepiride, gliclazide, repaglinide, rosiglitazone and insulin (Figure).
Conclusion: In a nationwide cohort of patients with diabetes but without prior MI, dual combinations of metformin with glibenclamide and glipizide are associated with increased cardiovascular risk compared to other combinations.
- © 2010 by American Heart Association, Inc.