Antihyperglycemic treatment in diabetics with coronary disease: Increased metformin-associated mortality over a 5-year follow-up
Antihyperglycemic treatment in diabetics with coronary disease: Increased metformin-associated mortality over a 5-year follow-up
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DOI：
10.1159/000006909
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发表时间：
1999-01-01
期刊：
影响因子：
1.9
通讯作者：
Motro, M
中科院分区：
文献类型：
--
作者：
Fisman, EZ;Tenebaum, A;Motro, M
慢性缺血性心脏病（IHD）合并非胰岛素依赖型糖尿病（NIDDM）患者的死亡率明显高于非糖尿病患者。不同类型的降糖药物治疗与NIDDM人群死亡率之间的关系尚不确定。我们的目的是研究在5年的随访期内，使用各种类型的口服降糖药治疗的NIDDM合并IHD患者的生存率。研究样本包括11，440例既往有心肌梗死和/或稳定性心绞痛综合征的患者，年龄45-74岁，他们接受了筛选，但未纳入苯扎贝特预防心肌梗死研究。其中，9，045人为非糖尿病患者，2，395人为糖尿病患者。根据筛选时的治疗方案将糖尿病患者分为4组：单纯饮食（n = 990）、磺脲类药物（n = 1，041）、二甲双胍（n = 78）和磺脲类药物和二甲双胍联合治疗（n = 266）。所有NIDDM组在年龄、性别、高血压、吸烟、心力衰竭、心绞痛和既往心肌梗死方面相似。非糖尿病组的粗死亡率较低（11.21 vs. 21.8%; p < 0.001）。在糖尿病组中，单纯饮食组的死亡率为18.5%，磺脲类药物组为22.5%，二甲双胍组为25.6%，磺脲类药物/二甲双胍联合组为31.6%（p < 0.01）。当分析年龄校正的死亡率和精算生存曲线时，发现仅饮食治疗的患者死亡率最低，二甲双胍（单独或与磺脲类药物联合）治疗的患者死亡率最高。在调整了与长期预后相关的变量后，使用二甲双胍与全因死亡率的相对风险（RR）增加相关，为1.42（95% CI 1.10-1.85），而单独使用磺脲类药物则不然[RR 1.11（95% CI 0.90-1.36）]。单独使用二甲双胍或与磺脲类药物联合使用二甲双胍进行IHD的NIDDM患者死亡率显著增加。在口服控制NIDDM的问题导向前瞻性研究结果出来之前，应该对这些患者的替代治疗方法进行研究。
Mortality rates are considerably higher in chronic ischemic heart disease (IHD) patients with non-insulin-dependent diabetes mellitus (NIDDM) than in those who are nondiabetics. The relationship between different types of antihyperglycemic pharmacological therapy and mortality rate in this NIDDM population is uncertain. We aimed to examine the survival in NIDDM patients with IHD using various types of oral antidiabetic treatments over a 5-year follow-up period. The study sample comprised 11,440 patients with a previous myocardial infarction and/or stable anginal syndrome, aged 45-74 years, who were screened, but not included in the Bezafibrate Infarction Prevention study. Among them, 9,045 were nondiabetics and 2,395 diabetics. The diabetic patients were divided into four groups on the basis of their therapeutic regimen at screening: diet alone (n = 990), sulfonylureas (n = 1,041), metformin (n = 78) and a combination of a sulfonylurea and metformin (n = 266). All NIDDM groups were similar with regard to age, gender, hypertension, smoking, heart failure, angina and prior myocardial infarction. Crude mortality rate was lower in the nondiabetic group (11.21 vs. 21.8%; p < 0.001). In the diabetic group, mortality was 18.5% for patients on diet alone, 22.5% for those on sulfonylureas, 25.6% for patients on metformin, and 31.6% for the combined sulfonylurea/metformin group (p < 0.01). When analyzing age-adjusted mortality rate a nd actuarial survival curves, the lowest mortality was found in patients on diet alone and the highest in patients on metformin (alone or in combination with sulfonylureas). After adjustment for variables connected with long-term prognosis, the use of metformin was associated with increased relative risk (RR) for all-cause mortality of 1.42 (95% CI 1.10-1.85), whereas the use of sulfonylureas alone was not [RR 1.11 (95% CI 0.90-1.36)]. NIDDM patients with IHD using metformin, alone or in combination with sulfonylureas, exhibited a significantly increased mortality. Until the results of problem-oriented prospective studies on oral control of NIDDM will be available, alternative therapeutic approaches should be investigated in these patients.