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Article: Metformin versus sulphonylureas for new onset atrial fibrillation and stroke in type 2 diabetes mellitus: a population-based study

TitleMetformin versus sulphonylureas for new onset atrial fibrillation and stroke in type 2 diabetes mellitus: a population-based study
Authors
KeywordsAtrial fibrillation
Big data
Diabetes
Metformin
Stroke
Sulphonylurea
Issue Date2022
Citation
Acta Diabetologica, 2022, v. 59, n. 5, p. 697-709 How to Cite?
AbstractAims: To gain insights on the cardiovascular effects of metformin and sulphonylurea, the present study compares the rates of incident atrial fibrillation, stroke, cardiovascular mortality and all-cause mortality between metformin and sulphonylurea users in type 2 diabetes mellitus. Methods: This was a retrospective population-based cohort study of type 2 diabetes mellitus patients receiving either sulphonylurea or metformin monotherapy between January 1, 2000, and December 31, 2019. The primary outcome was new-onset AF or stroke. Secondary outcomes were cardiovascular, non-cardiovascular and all-cause mortality. Propensity score matching (1:2 ratio) between sulphonylurea and metformin users was performed, based on demographics, CHA-DS-VASc score, past comorbidities and medication use. Cox regression was used to identify significant risk factors. Competing risk analysis was conducted using cause-specific and subdistribution hazard models. Sensitivity analyses using propensity score stratification, high-dimensional propensity score and inverse probability of treatment weighting were conducted. Subgroup analyses were conducted for age and gender in the matched cohort. Results: A total of 36,228 sulphonylurea users and 72,456 metformin users were included in the propensity score-matched cohort. Multivariable Cox regression showed that sulphonylurea users had higher risks of incident AF (hazard ratio [HR]: 2.89, 95% confidence interval [CI]: 2.75–3.77;P < 0.0001), stroke (HR: 3.23, 95% CI: 3.01–3.45; P < 0.0001), cardiovascular mortality (HR: 3.60, 95% CI: 2.62–4.81; P < 0.0001) and all-cause mortality (HR: 4.35, 95% CI: 3.16–4.75; P < 0.0001) compared to metformin users. Similarly, significant results were observed using cause-specific and subdistribution hazard models. Sensitivity analysis using techniques based on the propensity score also yielded similar results. Conclusions: Sulphonylurea use was associated with higher risks of incident AF, stroke, cardiovascular mortality and all-cause mortality compared to metformin. Males and patients older than 65 years with sulphonylurea use were exposed to the highest risks.
Persistent Identifierhttp://hdl.handle.net/10722/330758
ISSN
2023 Impact Factor: 3.1
2023 SCImago Journal Rankings: 0.980
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorZhou, Jiandong-
dc.contributor.authorZhang, Guoming-
dc.contributor.authorChang, Carlin-
dc.contributor.authorChou, Oscar Hou In-
dc.contributor.authorLee, Sharen-
dc.contributor.authorLeung, Keith Sai Kit-
dc.contributor.authorWong, Wing Tak-
dc.contributor.authorLiu, Tong-
dc.contributor.authorWai, Abraham Ka Chung-
dc.contributor.authorCheng, Shuk Han-
dc.contributor.authorZhang, Qingpeng-
dc.contributor.authorTse, Gary-
dc.date.accessioned2023-09-05T12:13:58Z-
dc.date.available2023-09-05T12:13:58Z-
dc.date.issued2022-
dc.identifier.citationActa Diabetologica, 2022, v. 59, n. 5, p. 697-709-
dc.identifier.issn0940-5429-
dc.identifier.urihttp://hdl.handle.net/10722/330758-
dc.description.abstractAims: To gain insights on the cardiovascular effects of metformin and sulphonylurea, the present study compares the rates of incident atrial fibrillation, stroke, cardiovascular mortality and all-cause mortality between metformin and sulphonylurea users in type 2 diabetes mellitus. Methods: This was a retrospective population-based cohort study of type 2 diabetes mellitus patients receiving either sulphonylurea or metformin monotherapy between January 1, 2000, and December 31, 2019. The primary outcome was new-onset AF or stroke. Secondary outcomes were cardiovascular, non-cardiovascular and all-cause mortality. Propensity score matching (1:2 ratio) between sulphonylurea and metformin users was performed, based on demographics, CHA-DS-VASc score, past comorbidities and medication use. Cox regression was used to identify significant risk factors. Competing risk analysis was conducted using cause-specific and subdistribution hazard models. Sensitivity analyses using propensity score stratification, high-dimensional propensity score and inverse probability of treatment weighting were conducted. Subgroup analyses were conducted for age and gender in the matched cohort. Results: A total of 36,228 sulphonylurea users and 72,456 metformin users were included in the propensity score-matched cohort. Multivariable Cox regression showed that sulphonylurea users had higher risks of incident AF (hazard ratio [HR]: 2.89, 95% confidence interval [CI]: 2.75–3.77;P < 0.0001), stroke (HR: 3.23, 95% CI: 3.01–3.45; P < 0.0001), cardiovascular mortality (HR: 3.60, 95% CI: 2.62–4.81; P < 0.0001) and all-cause mortality (HR: 4.35, 95% CI: 3.16–4.75; P < 0.0001) compared to metformin users. Similarly, significant results were observed using cause-specific and subdistribution hazard models. Sensitivity analysis using techniques based on the propensity score also yielded similar results. Conclusions: Sulphonylurea use was associated with higher risks of incident AF, stroke, cardiovascular mortality and all-cause mortality compared to metformin. Males and patients older than 65 years with sulphonylurea use were exposed to the highest risks.-
dc.languageeng-
dc.relation.ispartofActa Diabetologica-
dc.subjectAtrial fibrillation-
dc.subjectBig data-
dc.subjectDiabetes-
dc.subjectMetformin-
dc.subjectStroke-
dc.subjectSulphonylurea-
dc.titleMetformin versus sulphonylureas for new onset atrial fibrillation and stroke in type 2 diabetes mellitus: a population-based study-
dc.typeArticle-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1007/s00592-021-01841-4-
dc.identifier.pmid35112189-
dc.identifier.scopuseid_2-s2.0-85124081987-
dc.identifier.volume59-
dc.identifier.issue5-
dc.identifier.spage697-
dc.identifier.epage709-
dc.identifier.eissn1432-5233-
dc.identifier.isiWOS:000750594000001-

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