Abstract 11383: Glucose-Lowering Medications and Angina Burden in Patients With Stable Coronary Disease. Results From the TERISA Trial
Background: Different classes of glucose-lowering medications have been associated with varying risks of myocardial infarction and CV death, but their associations with angina severity are unknown.
Methods: The TERISA trial enrolled patients with type 2 diabetes (T2DM) and stable angina from 14 countries in 2011-12. For 4 weeks prior to randomization, an electronic daily diary was used to establish baseline weekly angina frequency and nitroglycerin (NTG) use. We examined the association of different glucose-lowering medication classes with baseline angina and NTG use using multivariable linear regression. We also examined interactions between classes of medications.
Results: Among 952 patients enrolled, 494 were taking metformin, 504 taking a sulfonylurea, 186 taking insulin, 29 taking DPP-4 inhibitors, 22 taking other glucose-lowering medications, and 68 were diet-controlled only. After adjustment for demographic and clinical factors, patients taking vs. not taking sulfonylureas had 1.02 more episodes of angina and used 0.81 more doses of NTG per week (Table). The weekly angina burden or NTG use was not different for those taking vs. not taking metformin. Patients taking vs. not taking insulin had 0.84 more episodes of angina and used 1.15 more NTG doses per week, increases evident only in those taking insulin without concomitant metformin (pinteraction=0.05 for both). The small group of patients on DPP-4 inhibitors tended to use 1.77 fewer NTG doses per week compared with those not taking these agents.
Conclusion: Different classes of glucose-lowering medications were associated with varying angina burden in patients with T2DM and stable CAD. Patients taking sulfonylureas or insulin had more angina and used more NTG, while metformin was not associated with angina burden. Given the increasing prevalence of glucose abnormalities in patients with CAD, a better understanding of the relationship between glucose-lowering medications and angina is needed.
Author Disclosures: S.V. Arnold: None. D.K. McGuire: Consultant/Advisory Board; Modest; Janssen Pharmaceuticals, Daiichi Sankyo, Pfizer, Boehringer-Ingelheim, Regeneron, Genentech, F Hoffmann-La Roche, Merck, Bristol-Myers Squibb, AstraZeneca, Orexigen, Eli Lilly, Novo Nordisk, Lexicon, Eisai, GlaxoSmithKline, Takeda. J.A. Spertus: Research Grant; Modest; Gilead Sciences, NHLBI, ACCF, AHA, PCORI, Amorcyte, Genentech, Eli Lilly. Ownership Interest; Modest; SAQ, KCCQ, PAQ. Consultant/Advisory Board; Modest; Gilead Sciences, Genentech, Amgen, United Healthcare, Health Outcomes Sciences. Y. Li: None. P. Yue: Employment; Significant; Gilead Sciences. Other; Significant; Gilead Sciences (stock and stock options). S.E. Inzucchi: None. L. Belardinelli: Employment; Significant; Gilead Sciences. Other; Significant; Gilead Sciences (stock and stock options). B.R. Chaitman: Speakers Bureau; Modest; Gilead Sciences. Honoraria; Modest; Gilead Sciences. Consultant/Advisory Board; Modest; Gilead Sciences, Merck, Pfizer, Eli Lilly, Janssen. Research Grant; Significant; Gilead Sciences, NHLBI. Consultant/Advisory Board; Significant; Sanofi-Aventis. M. Kosiborod: Research Grant; Modest; Gilead Sciences, AHA, Medtronic Minimed, Genentech, Sanofi-Aventis, Glumetrics, Maquet, Eisai. Consultant/Advisory Board; Modest; Gilead Sciences, Genentech, F Hoffmann-La Roche, Medtronic Minimed, AstraZeneca, Abbvie, Regeneron, Edwards Lifesciences, Eli Lilly.
- © 2014 by American Heart Association, Inc.