title: Effects of metformin versus glipizide on cardiovascular outcomes in patients with type 2 diabetes and coronary artery disease.
abstract: OBJECTIVE
  The two major classes of antidiabetic drugs, sulfonylureas and metformin, may differentially affect macrovascular complications and mortality in diabetic patients. We compared the long-term effects of glipizide and metformin on the major cardiovascular events in type 2 diabetic patients who had a history of coronary artery disease (CAD).
  
  
  METHODS
  This study is a multicenter, randomized, double-blind, placebo-controlled clinical trial. A total of 304 type 2 diabetic patients with CAD, mean age = 63.3 years (range, 36-80 years), were enrolled. Participants were randomly assigned to receive either glipizide (30 mg daily) or metformin (1.5 g daily) for 3 years. The primary end points were times to the composite of recurrent cardiovascular events, including death from a cardiovascular cause, death from any cause, nonfatal myocardial infarction, nonfatal stroke, or arterial revascularization.
  
  
  RESULTS
  At the end of study drug administration, both groups achieved a significant decrease in the level of glycated hemoglobin (7.1% in the glipizide group and 7.0% in the metformin group). At a median follow-up of 5.0 years, 91 participants had developed 103 primary end points. Intention-to-treat analysis showed an adjusted hazard ratio (HR) of 0.54 (95% CI 0.30-0.90; P = 0.026) for the composites of cardiovascular events among the patients that received metformin, compared with glipizide. The secondary end points and adverse events were not significantly different between the two groups.
  
  
  CONCLUSIONS
  Treatment with metformin for 3 years substantially reduced major cardiovascular events in a median follow-up of 5.0 years compared with glipizide. Our results indicated a potential benefit of metformin therapy on cardiovascular outcomes in high-risk patients.
authors.affiliation: Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Hong
authors.forename: Yifei
authors.initials: Y
authors.lastname: Zhang
authors.forename: Shenghan
authors.initials: S
authors.lastname: Lai
authors.forename: Ankang
authors.initials: A
authors.lastname: Lv
authors.forename: Qing
authors.initials: Q
authors.lastname: Su
authors.forename: Yan
authors.initials: Y
authors.lastname: Dong
authors.forename: Zhiguang
authors.initials: Z
authors.lastname: Zhou
authors.forename: Weili
authors.initials: W
authors.lastname: Tang
authors.forename: Jiajun
authors.initials: J
authors.lastname: Zhao
authors.forename: Lianqun
authors.initials: L
authors.lastname: Cui
authors.forename: Dajin
authors.initials: D
authors.lastname: Zou
authors.forename: Dawang
authors.initials: D
authors.lastname: Wang
authors.forename: Hong
authors.initials: H
authors.lastname: Li
authors.forename: Chao
authors.initials: C
authors.lastname: Liu
authors.forename: Guoting
authors.initials: G
authors.lastname: Wu
authors.forename: Jie
authors.initials: J
authors.lastname: Shen
authors.forename: Dalong
authors.initials: D
authors.lastname: Zhu
authors.forename: Weiqing
authors.initials: W
authors.lastname: Wang
authors.forename: Weifeng
authors.initials: W
authors.lastname: Shen
authors.forename: Guang
authors.initials: G
authors.lastname: Ning
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D005913:Glipizide / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged
chemical_list: D008687:Metformin; D005913:Glipizide