Case-control study of oral glucose-lowering drugs in combination with long-acting insulin and the risks of incident myocardial infarction and incident stroke.
Case-control study of oral glucose-lowering drugs in combination with long-acting insulin and the risks of incident myocardial infarction and incident stroke.
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DOI：
10.1002/pds.3914
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发表时间：
2016-02
影响因子：
2.6
通讯作者：
Psaty BM
中科院分区：
文献类型：
--
作者：
Floyd JS;Wiggins KL;Christiansen M;Dublin S;Longstreth WT;Smith NL;McKnight B;Heckbert SR;Weiss NS;Psaty BM
口服降糖疗法和胰岛素一起使用是很常见的，但对心血管的影响在很大程度上是未知的。在长效胰岛素使用者中，我们进行了一项基于人群的病例对照研究，以评估与使用磺脲类药物和使用二甲双胍相关的心肌梗死(MI)事件和中风事件风险。研究对象为1995年至2010年间首次心肌梗死(n=413)或首次中风(n=247)确诊时使用长效胰岛素的2型糖尿病患者。使用长效胰岛素的2型糖尿病对照组(n=443)在年龄、性别和日历年上与患者匹配。磺酰脲和二甲双胍的使用被归类为当前、过去或从未使用电子药房记录。心肌梗死和中风的诊断通过病历审查得到证实。对潜在的混杂因素进行了分析调整。与从未使用磺脲类药物相比，目前使用磺脲类药物的患者发生心肌梗死的风险更高(OR 1.67；95%CI，1.10-2.55)，但与中风无关(OR 1.22；95%CI，0.74-2.00)。与从不使用二甲双胍相比，目前使用二甲双胍与较低的中风风险(OR 0.54；95%CI，0.31-0.95)相关，但与MI(OR 0.77；95%CI，0.44-1.33)无关。既往使用磺脲类药物和既往使用二甲双胍与上述两种结果均无关联。与单独使用胰岛素相比，磺脲类药物联合长效胰岛素可能会增加心肌梗死的风险。二甲双胍可能是胰岛素治疗患者的一种重要的心血管疾病预防疗法。
The use of oral glucose-lowering therapies with insulin is common, but the cardiovascular effects are largely unknown. Among users of long-acting insulin, we conducted a population-based case-control study to evaluate the incident myocardial infarction (MI) and incident stroke risks associated with the use of sulfonylureas and the use of metformin. Cases were Group Health Cooperative enrollees with type 2 diabetes who used long-acting insulin at the time of diagnosis with a first MI (n=413) or first stroke (n=247) from 1995-2010. Controls (n=443) with type 2 diabetes who used long-acting insulin were matched to cases on age, sex, and calendar year. Sulfonylurea and metformin use was classified as current, past, or never using electronic pharmacy records. MI and stroke diagnoses were validated by medical record review. Analyses were adjusted for potential confounders. Current use of sulfonylureas compared with never use was associated with a higher risk of MI (OR 1.67; 95% CI, 1.10-2.55) but not stroke (OR 1.22; 95% CI, 0.74-2.00). Current use of metformin compared with never use was associated with a lower risk of stroke (OR 0.54; 95% CI, 0.31-0.95) but not MI (OR 0.77; 95% CI, 0.44-1.33). Past use of sulfonylureas and past use of metformin were not associated with either outcome. Sulfonylureas in combination with long-acting insulin may increase the risk of MI compared with the use of insulin alone. Metformin may be an important cardiovascular disease prevention therapy for patients on insulin therapy.