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Study Compares Cardiac, Death Risks of Diabetes Drugs

Uunfavourable risk profile for sulphonylurea drugs; thiazolidinediones safer, study finds

FRIDAY, Dec. 4 (HealthDay News) -- Use of the sulphonylurea class of drugs for diabetes carries elevated risks of cardiac and all-cause death, while among drugs in the thiazolidinedione class, pioglitazone posed the lowest risk, according to an analysis published online Dec. 3 in BMJ.

Ioanna Tzoulaki, Ph.D., of the Imperial College London, and colleagues analyzed data on 91,521 people with diabetes in the United Kingdom's general practice research database. The researchers correlated patient outcomes, including myocardial infarction, congestive heart failure and all-cause mortality with drug treatment by drug class.

The investigators note that there were 3,588 incidents of myocardial infarction, 6,900 incidents of congestive heart failure, and 18,548 deaths in the database. Compared to metformin, second generation sulphonylureas carried a 24 to 61 percent excess risk for all-cause mortality, and an 18 to 30 percent excess risk for congestive heart failure. In the thiazolidinedione class, pioglitazone had a 31 to 39 percent lower risk of all-cause mortality compared to metformin, while rosiglitazone had a 34 to 41 percent higher risk of all-cause mortality compared with pioglitazone. Overall, the thiazolidinedione class was not associated with risk of myocardial infarction.

"Our findings suggest a relatively unfavorable risk profile of sulphonylureas compared with metformin for all outcomes examined. Pioglitazone was associated with reduced all-cause mortality compared with metformin. Pioglitazone also had a favorable risk profile compared with rosiglitazone; although this requires replication in other studies, it may have implications for prescribing within this class of drugs," the authors write.

Several authors reported financial relationships with the pharmaceutical industry.

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