| アブストラクト | AIMS: To determine whether adiposity modified the effect on the cardiovascular safety of sulphonylureas as a first-line therapy compared with metformin among patients with type 2 diabetes. MATERIALS AND METHODS: Using the UK Clinical Practice Research Datalink, we conducted a cohort study among 13 862 new sulphonylurea users matched on body mass index (BMI) and propensity score, in a 1:1 ratio, to new metformin users between April 1, 1998 and December 31, 2016. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) of major adverse cardiovascular events (MACE), individual components of MACE (myocardial infarction [MI], ischaemic stroke, cardiovascular mortality), and all-cause mortality, comparing use of sulphonylureas with use of metformin, overall and within BMI categories (</=24.9 kg/m(2) , 25.0-29.9 kg/m(2) , >/=30 kg/m(2) ). RESULTS: Compared with metformin, sulphonylureas were not associated with an increased risk of MACE either overall (HR 1.08, 95% CI 0.94-1.23) or by BMI category. Similar findings were observed for MI and ischaemic stroke. By contrast, sulphonylureas were associated with an increased risk of cardiovascular mortality (HR 1.24, 95% CI 1.04-1.48), primarily among obese patients (HR 1.52, 95% CI 1.08-2.13), and not among normal-weight patients (HR 1.00, 95% CI 0.72-1.39; P-interaction 0.21). Similar results were observed for all-cause mortality (HR 1.47, 95% CI 1.32-1.62), where an increased risk was observed among obese patients (HR 1.83, 95% CI 1.49-2.25), but not normal-weight patients (HR 1.18, 95% CI 0.99-1.42; P-interaction: 0.006). CONCLUSION: The findings of this study suggest that adiposity may have a modifying effect on the association between sulphonylureas and cardiovascular and all-cause mortality compared with metformin. |
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| ジャーナル名 | Diabetes, obesity & metabolism |
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| 投稿日 | 2021/7/13 |
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| 投稿者 | Suissa, Karine; Schneeweiss, Sebastian; Douros, Antonios; Filion, Kristian B; Yin, Hui; Patorno, Elisabetta; Azoulay, Laurent |
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| 組織名 | Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine,;Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.;Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital,;Montreal, Quebec, Canada.;Department of Epidemiology, Biostatistics, and Occupational Health, McGill;University, Montreal, Quebec, Canada.;Department of Medicine, McGill University, Montreal, Quebec, Canada.;Institute of Clinical Pharmacology and Toxicology, Charite - Universitatsmedizin;Berlin, Berlin, Germany.;Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec,;Canada. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/34251086/ |
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