Risk of MACE higher with sulfonylureas vs DPP4is

In the treatment of patients with type 2 diabetes (T2D), sulfonylureas pose an increased risk of major adverse cardiovascular events (MACE) compared with dipeptidyl peptidase 4 inhibitors (DPP4is), according to a study.

The study included 48,165 adults with T2D (median age 61 years, 47.1 percent female), among whom 18,147 were initiated on glipizide, 14,282 on glimepiride, 1,887 on glyburide, and 13,849 on a DPP4i. These drugs were given in the second-line setting, after metformin.

The primary outcome was a four-point composite of MACE: myocardial infarction, ischaemic stroke, heart failure hospitalization, or cardiovascular death. The 5-year risk was assessed.

At baseline, the median HbA1C of the patients was 7.8 percent, while the median low-density lipoprotein cholesterol was 89 mg/dL.

MACE occurred in 3,158 participants (6.6 percent) over a median follow-up of 37 months. The estimated 5-year risk of the composite of MACE was 8.1 percent (95 percent confidence interval [CI], 7.5–8.7) with DPP4i, 8.4 percent (95 percent CI, 6.8–9.9) with glyburide, 8.6 percent (95 percent CI, 7.9–9.2) with glimepiride, and 9.1 percent (95 percent CI, 8.7–9.7) with glipizide.

Among sulfonylureas, the 5-year of risk MACE was highest with glipizide (risk ratio [RR], 1.13, 95 percent CI, 1.03–1.23) than with glimepiride (RR, 1.07, 95 percent CI, 0.96–1.16) and glyburide (RR, 1.04, 95 percent CI, 0.83–1.24) vs DDP4is.