Compared to metformin, sulfonylurea use was not associated with a higher risk of hospitalization for heart failure (HHF) but was associated with a higher risk of all-cause mortality. The findings were presented at the 2017 American Heart Association (AHA)’s Scientific Sessions.

To better understand the effects of diabetes drug therapy in patients with heart failure, researchers aimed to compare the efficacy of sulfonylurea and biguanide (eg, metformin) drugs—the 2 most popular classes of antidiabetic drugs—in this patient population. 

Data from the Duke University Health System (DUHS) electronic health records were used to identify patients with both diabetes and heart failure; the inclusion date was the first date when a patient had both diagnoses in the record. Study authors used a Cox proportional hazards model to evaluate the use of these agents for the outcome of hospitalization for heart failure (HHF) and all-cause mortality. 

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Of the total 9,418 identified patients, 13% (n=1,226) were prescribed a sulfonylurea, 16% (n=1,530) were prescribed metformin, and 5% (n=486) were prescribed both drugs; study patients taking metformin were slightly younger than sulfonylurea users (median age 66.2 vs. 71.1 years). After adjusting for multiple variables, the authors found sulfonylurea use was not associated with a higher risk of HHF (hazard ratio [HR] 0.99, 95% CI: 0.83–1.08), however it was associated with an increased risk for all-cause mortality (sulfonylurea 25.4% vs. metformin 15.8%; HR 1.15, 95 %CI: 1.09–1.76).  

Based on these findings, the authors call for prospective randomized trials evaluating sulfonylurea vs. metformin in patients with comorbid diabetes and heart failure. 

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