title: Associations between the use of metformin, sulphonylureas, or diet alone and cardiovascular outcomes in 6005 people with type 2 diabetes in the FIELD study.
abstract: OBJECTIVE
  We aimed to determine the associations between metformin or sulphonylurea monotherapy at study entry into the FIELD diabetes trial and (1) metabolic risk factors, (2) risk of a first major cardiovascular (CVD) outcome, and (3) the effect of each therapy on the risk-modifying effect of fenofibrate.
  
  
  METHODS
  Patients receiving metformin or sulphonylureas without insulin therapy were compared for the relative risk of CVD outcomes, adjusted for differences in baseline characteristics likely to affect risk.
  
  
  RESULTS
  Metformin-treated patients were likely to be younger, female, or obese. Metformin was associated with higher levels of lipids (other than LDL-C) and homocysteine (P<0.001). Sulphonylurea-treated patients had a longer history of diabetes and more CVD and microvascular disease. Sulphonylurea treatment was associated with higher plasma creatinine and lower plasma HDL-C (P<0.001). The risks of all CVD outcomes were higher for those on sulphonylureas than diet alone, but were nonsignificant after adjustment for the duration and intensity of diabetes and severity of risk factors. Metformin and sulphonylureas did not significantly influence the benefits of fenofibrate on CVD outcomes.
  
  
  CONCLUSIONS
  Apparent differences in the risk of CVD outcomes associated with oral hypoglycemics therapy were largely abolished by adjustment for diabetes and CVD risk factors.
authors.affiliation: Department of Clinical Biochemistry, Royal Prince Alfred Hospital, Sydney, NSW, Australia. david.sullivan@sswahs.nsw.gov.au
authors.forename: David
authors.initials: D
authors.lastname: Sullivan
authors.forename: Peta
authors.initials: P
authors.lastname: Forder
authors.forename: John
authors.initials: J
authors.lastname: Simes
authors.forename: Malcolm
authors.initials: M
authors.lastname: Whiting
authors.forename: Leonard
authors.initials: L
authors.lastname: Kritharides
authors.forename: Alistair
authors.initials: A
authors.lastname: Merrifield
authors.forename: Mark
authors.initials: M
authors.lastname: Donoghoe
authors.forename: Peter G
authors.initials: PG
authors.lastname: Colman
authors.forename: Neil
authors.initials: N
authors.lastname: Graham
authors.forename: Hannu
authors.initials: H
authors.lastname: Haapamäki
authors.forename: Anthony
authors.initials: A
authors.lastname: Keech
mesh_terms: D000284:Administration, Oral; D000368:Aged; D001315:Australia; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000178:diet therapy* / Q000188:drug therapy*; D005260:Female; D011345:Fenofibrate / Q000627:therapeutic use*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008687:Metformin / Q000008:administration & dosage*; D008875:Middle Aged; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013453:Sulfonylurea Compounds / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D013453:Sulfonylurea Compounds; D008687:Metformin; D011345:Fenofibrate