Risk of coronary artery disease associated with initial sulphonylurea treatment of patients with type 2 diabetes: A matched case–control study

AimsThis study sought to assess the risk of developing coronary artery disease (CAD) associated with initial treatment of type 2 diabetes with different sulphonylureas.MethodsIn type 2 diabetic patients, cases who developed CAD were compared retrospectively with controls that did not. The 20-year risk of CAD at diagnosis of diabetes, using the UKPDS risk engine, was used to match cases with controls.ResultsThe 76 cases of CAD were compared with 152 controls. The hazard of developing CAD (95% CI) associated with initial treatment increased by 2.4-fold (1.3–4.3, P = 0.004) with glibenclamide; 2-fold (0.9–4.6, P = 0.099) with glipizide; 2.9-fold (1.6–5.1, P = 0.000) with either, and was unchanged with metformin. The hazard decreased 0.3-fold (0.7–1.7, P = 0.385) with glimepiride, 0.4-fold (0.7–1.3, P = 0.192) with gliclazide, and 0.4-fold (0.7–1.1, P = 0.09) with either.ConclusionsInitiating treatment of type 2 diabetes with glibenclamide or glipizide is associated with increased risk of CAD in comparison to gliclazide or glimepiride. If confirmed, this may be important because most Indian patients receive the cheaper older sulphonylureas, and present guidelines do not distinguish between individual agents.