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Cardiac risks lower with glyburide vs. other sulfonylureas
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Adults with type 2 diabetes prescribed glyburide may have lower risks for sudden cardiac arrest and ventricular arrhythmia compared with those prescribed glipizide and glimepiride, according to researchers assessing the cardiac effects of different sulfonylureas.
Charles E. Leonard, PharmD, MSCE, research assistant professor in the Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics and the department of biostatistics, epidemiology and informatics at Perelman School of Medicine at the University of Pennsylvania, and colleagues evaluated data from 1999 to 2010 U.S. Medicaid claims on 519,272 adults with type 2 diabetes using sulfonylureas (60.3% women; 34.9% white; median age, 58 years). Researchers sought to determine associations between individual sulfonylureas and sudden cardiac arrest and ventricular arrhythmia.
Participants were users of glyburide (n = 202,148), glimepiride (n = 97,520) or glipizide (reference exposure; n = 219,604).
During 176,889 person-years of follow-up, there were 632 sudden cardiac arrest/ventricular arrhythmia outcomes for an incidence rate of 3.6 per 1,000 person-years. When researchers limited follow-up to the first 30 days after receiving a first prescription, there were 221 sudden cardiac arrest/ventricular arrhythmia outcomes during 38,180 person-years of follow-up for an incidence rate of 5.8 per 1,000 person-years. The crude incidence rate for sudden cardiac death was 1.8 per 1,000 person-years and 3.1 per 1,000 person-years for fatal ventricular arrhythmia.
Compared with glipizide, the rates of sudden cardiac arrest/ventricular arrhythmia were lower with glyburide (propensity score-adjusted HR = 0.82; 95% CI, 0.69-0.98). The propensity score-adjusted HR for sudden cardiac arrest/ventricular arrhythmia was 1.1 (95% CI, 0.89-1.36) for glimepiride compared with glipizide.
“We found that glyburide may be associated with an 18% reduction in [sudden cardiac arrest/ventricular arrhythmia] risk compared with glipizide,” the researchers wrote. “This finding is consistent with small clinical studies in humans demonstrating anti-arrhythmic properties of glyburide, particularly in settings of acute ischemia. A clinician with a desire to treat a patient with type 2 [diabetes] with a sulfonylurea may wish to consider glyburide’s potential ability to reduce the risk of serious arrhythmia — surely to be considered along with its increased rate of serious hypoglycemia vs. other sulfonylureas and its debated effects on other cardiovascular endpoints (including cardiovascular death), cerebrovascular endpoints and all-cause death.” – by Amber Cox
Disclosures: Leonard reports he receives salary support from the Harvard Pilgrim Health Institute for sulfonylurea-related work conducted on behalf of the FDA (outside of the submitted work). Please see the study for all other authors’ relevant financial disclosures.
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