Sulfonylurea Is Associated With Higher Risks of Ventricular Arrhythmia or Sudden Cardiac Death Compared With Metformin: A Population-Based Cohort Study

Teddy Tai Loy Lee, Jeremy Man Ho Hui, Yan Hiu Athena Lee, Danish Iltaf Satti, Yuki Ka Ling Shum, Pias Tang Hoi Kiu, Abraham Ka Chung Wai, Tong Liu, Wing Tak Wong, Jeffrey Shi Kai Chan, Bernard Man Yung Cheung, Ian Chi Kei Wong, Shuk Han Cheng, Gary Tse

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)

Abstract

BACKGROUND: Commonly prescribed diabetic medications such as metformin and sulfonylurea may be associated with different arrhythmogenic risks. This study compared the risk of ventricular arrhythmia or sudden cardiac death between metformin and sulfonylurea users in patients with type 2 diabetes. METHODS AND RESULTS: Patients aged ≥40 years who were diagnosed with type 2 diabetes or prescribed antidiabetic agents in Hong Kong between January 1, 2009, and December 31, 2009, were included and followed up until December 31, 2019. Patients prescribed with both metformin and sulfonylurea or had prior myocardial infarction were excluded. The study outcome was a composite of ventricular arrhythmia or sudden cardiac death. Metformin users and sulfonylurea users were matched at a 1:1 ratio by propensity score matching. The matched cohort consisted of 16 596 metformin users (47.70% men; age, 68±11 years; mean follow-up, 4.92±2.55 years) and 16 596 sulfonylurea users (49.80% men; age, 70±11 years; mean follow-up, 4.93±2.55 years). Sulfonylurea was associated with higher risk of ventricular arrhythmia or sudden cardiac death than metformin hazard ratio (HR, 1.90 [95% CI, 1.73– 2.08]). Such difference was consistently observed in subgroup analyses stratifying for insulin usage or known coronary heart disease. CONCLUSIONS: Sulfonylurea use is associated with higher risk of ventricular arrhythmia or sudden cardiac death than metformin in patients with type 2 diabetes.

Original languageEnglish
Article numbere026289
JournalJournal of the American Heart Association
Volume11
Issue number18
DOIs
Publication statusPublished - 20 Sept 2022
Externally publishedYes

Keywords

  • metformin
  • sudden cardiac death
  • sulfonylurea
  • type 2 diabetes
  • ventricular arrhythmia

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