Are users of sulphonylureas at the time of an acute coronary syndrome at risk of poorer outcomes?

被引:16
作者
Nagendran, J. [1 ,2 ]
Oudit, G. Y. [2 ,3 ]
Bakal, J. A. [4 ,5 ]
Light, P. E. [6 ]
Dyck, J. R. B. [2 ,6 ,7 ]
McAlister, F. A. [4 ,5 ]
机构
[1] Univ Alberta, Mazankowski Alberta Heart Inst, Dept Surg, Div Cardiac Surg, Edmonton, AB T6G 2R7, Canada
[2] Univ Alberta, Mazankowski Alberta Heart Inst, Fac Med & Dent, Cardiovasc Res Ctr, Edmonton, AB T6G 2R7, Canada
[3] Univ Alberta, Mazankowski Alberta Heart Inst, Fac Med & Dent, Div Cardiol,Dept Med, Edmonton, AB T6G 2R7, Canada
[4] Univ Alberta, Div Gen Internal Med, Dept Med, Edmonton, AB T6G 2R7, Canada
[5] Univ Alberta, Patient Hlth Outcomes Res & Clin Effectiveness Un, Dept Med, Edmonton, AB T6G 2R7, Canada
[6] Univ Alberta, Dept Pharmacol, Edmonton, AB T6G 2R7, Canada
[7] Univ Alberta, Dept Pediat, Edmonton, AB T6G 2R7, Canada
关键词
cardiovascular disease; diabetes mellitus; sulphonylureas; K-ATP CHANNELS; GLUCOSE-LOWERING TREATMENT; MYOCARDIAL-INFARCTION; DIABETES-MELLITUS; CARDIOVASCULAR EVENTS; DRUGS; MORTALITY; IMPACT; INTERVENTION; GLICLAZIDE;
D O I
10.1111/dom.12126
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
AimsAdenosine triphosphate sensitive potassium (K-ATP) channel activity is cardioprotective during ischaemia. One of the purported mechanisms for sulphonylurea adverse effects is through inhibition of these channels. The purpose of this study is to examine whether patients using K-ATP channel inhibitors at the time of an acute coronary syndrome are at greater risk of death or heart failure (HF) than those not exposed. MethodsUsing linked administrative databases we identified all adults who had an acute coronary syndrome between April 2002 and October 2006 (n=21 023). ResultsWithin 30days of acute coronary syndrome, 5.3% of our cohort died and 15.6% were diagnosed with HF. Individuals with diabetes exhibited significantly higher risk of death (adjusted OR: 1.20, 95% CI: 1.03-1.40) and death or HF (aOR: 1.73, 95% CI: 1.59-1.89) than individuals without diabetes. However, there was no significantly increased risk of death (aOR: 1.00, 95% CI: 0.76-1.33) or death/HF (aOR: 1.06, 95% CI: 0.89-1.26) in patients exposed to K-ATP channel inhibitors versus patients not exposed to K-ATP channel inhibitors prior to their acute coronary syndrome. ConclusionsDiabetes is associated with an increased risk of death or HF within 30days of an acute coronary syndrome. However, we did not find any excess risk of death or HF associated with use of K-ATP channel inhibitors at the time of an acute coronary syndrome, raising doubts about the hypothesis that sulphonylureas inhibit the cardioprotective effects of myocardial K-ATP channels.
引用
收藏
页码:1022 / 1028
页数:7
相关论文
共 23 条
[1]  
Antman Elliott M., 2004, J Am Coll Cardiol, V44, pE1, DOI 10.1016/j.jacc.2004.07.014
[2]   Diabetes and mortality following acute coronary syndromes [J].
Donahoe, Sean M. ;
Stewart, Garrick C. ;
McCabe, Carolyn H. ;
Mohanavelu, Satishkumar ;
Murphy, Sabina A. ;
Cannon, Christopher P. ;
Antman, Elliott M. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2007, 298 (07) :765-775
[3]   Sulfonylurea drugs increase early mortality in patients with diabetes mellitus after direct angioplasty for acute myocardial infarction [J].
Garratt, KN ;
Brady, PA ;
Hassinger, NL ;
Grill, DE ;
Terzic, A ;
Holmes, DR .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1999, 33 (01) :119-124
[4]   The accuracy of using integrated electronic health care data to identify patients with undiagnosed diabetes mellitus [J].
Ho, Michael L. ;
Lawrence, Nadine ;
van Walraven, Carl ;
Manuel, Doug ;
Keely, Erin ;
Malcolm, Janine ;
Reid, Robert D. ;
Forster, Alan J. .
JOURNAL OF EVALUATION IN CLINICAL PRACTICE, 2012, 18 (03) :606-611
[5]   Type of preadmission glucose-lowering treatment and prognosis among patients hospitalised with myocardial infarction: a nationwide follow-up study [J].
Horsdal, H. T. ;
Johnsen, S. P. ;
Sondergaard, F. ;
Rungby, J. .
DIABETOLOGIA, 2008, 51 (04) :567-574
[6]   Effects of oral glucose-lowering drugs on long term outcomes in patients with diabetes mellitus following myocardial infarction not treated with emergent percutaneous coronary intervention - a retrospective nationwide cohort study [J].
Jorgensen, Casper H. ;
Gislason, Gunnar H. ;
Andersson, Charlotte ;
Ahlehoff, Ole ;
Charlot, Mette ;
Schramm, Tina K. ;
Vaag, Allan ;
Abildstrom, Steen Z. ;
Torp-Pedersen, Christian ;
Hansen, Peter R. .
CARDIOVASCULAR DIABETOLOGY, 2010, 9 :54
[7]   Adverse cardiovascular events during treatment with glyburide (glibenclamide) or gliclazide in a high-risk population [J].
Juurlink, D. N. ;
Gomes, T. ;
Shah, B. R. ;
Mamdani, M. M. .
DIABETIC MEDICINE, 2012, 29 (12) :1524-1528
[8]   Cardiac KATP channels in health and disease [J].
Kane, GC ;
Liu, XK ;
Yamada, S ;
Olson, TM ;
Terzic, A .
JOURNAL OF MOLECULAR AND CELLULAR CARDIOLOGY, 2005, 38 (06) :937-943
[9]   Gliclazide produces high-affinity block of KATP channels in mouse isolated pancreatic beta cells but not rat heart or arterial smooth muscle cells [J].
Lawrence, CL ;
Proks, P ;
Rodrigo, GC ;
Jones, P ;
Hayabuchi, Y ;
Standen, NB ;
Ashcroft, FM .
DIABETOLOGIA, 2001, 44 (08) :1019-1025
[10]   Impairment of myocardial protection in type 2 diabetic patients [J].
Lee, TM ;
Chou, TF .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2003, 88 (02) :531-537