title: The risk of developing coronary artery disease or congestive heart failure, and overall mortality, in type 2 diabetic patients receiving rosiglitazone, pioglitazone, metformin, or sulfonylureas: a retrospective analysis.
abstract: Oral anti-diabetic agents have been associated with adverse cardiovascular events in type 2 diabetes (DM2). We investigated the risk of coronary artery disease (CAD), congestive heart failure (CHF), and mortality using multivariable Cox models in a retrospective cohort of 20,450 DM2 patients from our electronic health record (EHR). We observed no differences in CAD risk among the agents. Metformin was associated with a reduced risk of CHF (HR 0.76, 95% CI 0.64-0.91) and mortality (HR 0.54, 95% CI 0.46-0.64) when compared to sulfonylurea. Pioglitazone was also associated with a lower risk of mortality when compared to sulfonylurea (HR 0.59, 95% CI 0.43-0.81). No other significant differences were found between the oral agents. In conclusions, our results did not identify an increased CAD risk with rosiglitazone in clinical practice. However, the results do reinforce a possible increased risk of adverse events in DM2 patients prescribed sulfonylureas.
authors.affiliation: Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue NA10, Cleveland, OH, 44195, USA. pantalk@ccf.org
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Pantalone
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.forename: Changhong
authors.initials: C
authors.lastname: Yu
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Wells
authors.forename: Susana
authors.initials: S
authors.lastname: Arrigain
authors.forename: Anil
authors.initials: A
authors.lastname: Jain
authors.forename: Ashish
authors.initials: A
authors.lastname: Atreja
authors.forename: Robert S
authors.initials: RS
authors.lastname: Zimmerman
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008687:Metformin / Q000009:adverse effects / Q000627:therapeutic use; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D000077154:Rosiglitazone; D012907:Smoking / Q000453:epidemiology; D013453:Sulfonylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use; D016019:Survival Analysis; D017741:Survivors; D045162:Thiazolidinediones / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones; D000077154:Rosiglitazone; D008687:Metformin