Diabetes drugs cleared of vascular harm
medwireNews: Two studies suggest that neither sulfonylureas nor sitagliptin increase the risk of adverse cardiovascular outcomes in patients with Type 2 diabetes.
The sulfonylurea study is a meta-analysis, published in PLoS Medicine and involving 37,650 patients who participated in 47 randomised trials. Researcher Dimitris Rados (Hospital de Clínicas de Porto Alegre, Brazil) and colleagues found that, overall, patients taking sulfonylureas had only slight, nonsignificant increases in cardiovascular and all-cause mortality.
It was a similar story for the more specific outcomes of myocardial infarction and stroke, and the results were unchanged when the team restricted the analysis to studies with at least 2 years of follow-up. Their analysis shows that, if sulfonylureas do carry a vascular risk, then it would require treatment of more than 200 patients for one event to emerge.
The researchers who assessed the vascular safety of sitagliptin did so as a secondary analysis of the randomised Trial Evaluating Cardiovascular Outcomes With Sitagliptin (TECOS), specifically looking at the risk of hospitalisation for heart failure among the 14,671 participants.
As reported in JAMA Cardiology, this outcome occurred in identical proportions of the sitagliptin and placebo groups – 3.1% – and the post-hospitalisation mortality rates were virtually the same between the groups, at a respective 29.8% and 28.8%.
Darren McGuire (University of Texas Southwestern Medical Center, Dallas, USA) and study co-authors say the findings “do not confirm” the possible increased heart failure risk noted in two previous trials of dipeptidyl peptidase 4 inhibitors, instead supporting the use of sitagliptin in Type 2 diabetes patients at high vascular risk.
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