The impact of antidiabetic medications on clinical outcomes in patients developing acute myocardial infarction (MI) is controversial.
In some studies, the use of early generation sulfonylurea drugs compared with no sulfonylureas or metformin is associated with increased mortality after myocardial infarction.
The newer sulfonylureas, gliclazide and glimepiride, are selective for the pancreatic sulfonylurea receptors over the cardiac receptors and do not appear to be associated with increased cardiovascular mortality compared with other diabetes medications.
In a study of 1310 patients with diabetes who were hospitalized for myocardial infarction, in-hospital mortality rates were significantly lower in patients previously treated with sulfonylureas compared with other oral medications, insulin, or no medication.
Among the sulfonylurea-treated patients, mortality was significantly lower in patients receiving gliclazide or glimepiride compared with glyburide, which is not selective for the pancreatic sulfonylurea receptors.
Source:
Zeller M, Danchin N, Simon D, et al. Impact of type of preadmission sulfonylureas on mortality and cardiovascular outcomes in diabetic patients with acute myocardial infarction. J Clin Endocrinol Metab 2010; 95:4993.