Risk of cardiovascular disease and all cause mortality among patients with type 2 diabetes prescribed oral antidiabetes drugs: retrospective cohort study using UK general practice research database

被引：292

作者：

Tzoulaki, Ioanna ^{[1
]}

Molokhia, Mariam ^{[2
]}

Curcin, Vasa ^{[3
]}

Little, Mark P. ^{[1
]}

Millett, Christopher J. ^{[4
]}

Ng, Anthea ^{[4
]}

Hughes, Robert I. ^{[5
]}

Khunti, Kamlesh ^{[6
]}

Wilkins, Martin R. ^{[5
]}

Majeed, Azeem ^{[4
]}

Elliott, Paul ^{[1
,7
]}

机构：

[1] Univ London Imperial Coll Sci Technol & Med, Fac Med, Dept Epidemiol & Publ Hlth, London W2 1PG, England

[2] London Sch Hyg & Trop Med, Dept Epidemiol & Populat Hlth, London, England

[3] Univ London Imperial Coll Sci Technol & Med, Dept Comp, London SW7 2AZ, England

[4] Univ London Imperial Coll Sci Technol & Med, Dept Primary Care & Social Med, London SW7 2AZ, England

[5] Univ London Imperial Coll Sci Technol & Med, Dept Expt Med & Toxicol, London SW7 2AZ, England

[6] Univ Leicester, Dept Hlth Sci, Leicester, Leics, England

[7] MRC HPA Ctr Environm & Hlth, London, England

来源：

BMJ-BRITISH MEDICAL JOURNAL | 2009年 / 339卷

基金：

英国医学研究理事会;

关键词：

CORONARY-HEART-DISEASE; MYOCARDIAL-INFARCTION; SULFONYLUREA DRUGS; GLYCEMIC CONTROL; OLDER PATIENTS; PIOGLITAZONE; THIAZOLIDINEDIONES; ROSIGLITAZONE; METFORMIN; OUTCOMES;

D O I：

10.1136/bmj.b4731

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective To investigate the risk of incident myocardial infarction, congestive heart failure, and all cause mortality associated with prescription of oral antidiabetes drugs. Design Retrospective cohort study. Setting UK general practice research database, 1990-2005. Participants 91 521 people with diabetes. Main outcome measures Incident myocardial infarction, congestive heart failure, and all cause mortality. Person time intervals for drug treatment were categorised by drug class, excluding non-drug intervals and intervals for insulin. Results 3588 incident cases of myocardial infarction, 6900 of congestive heart failure, and 18 548 deaths occurred. Compared with metformin, monotherapy with first or second generation sulphonylureas was associated with a significant 24% to 61% excess risk for all cause mortality (P<0.001) and second generation sulphonylureas with an 18% to 30% excess risk for congestive heart failure (P=0.01 and P<0.001). The thiazolidinediones were not associated with risk of myocardial infarction; pioglitazone was associated with a significant 31% to 39% lower risk of all cause mortality (P=0.02 to P<0.001) compared with metformin. Among the thiazolidinediones, rosiglitazone was associated with a 34% to 41% higher risk of all cause mortality (P=0.14 to P=0.01) compared with pioglitazone. A large number of potential confounders were accounted for in the study; however, the possibility of residual confounding or confounding by indication (differences in prognostic factors between drug groups) cannot be excluded. Conclusions Our findings suggest a relatively unfavourable risk profile of sulphonylureas compared with metformin for all outcomes examined. Pioglitazone was associated with reduced all cause mortality compared with metformin. Pioglitazone also had a favourable risk profile compared with rosiglitazone; although this requires replication in other studies, it may have implications for prescribing within this class of drugs.

引用

页数：9

共 45 条

[31] Coronary heart disease outcomes in patients receiving antidiabetic agents [J].