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

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.

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“…The first version, PowerAI-Diabetes, third-in-world, Chinese-specific AI-driven predictive model for predicting diabetic complications and first-in-world to incorporate lipid and glycaemic variability with AI, was recently developed 40 . We are incorporating new information such as treatment effects of first- and second-line anti-diabetic medications, such as metformin, sulphonylureas 41,42 , SGLT2 inhibitors, DPP4 inhibitors, GLP1 agonists 43,44 , which would impact on the risks of CVD and other adverse events. Our AI-enhanced diabetes model complement previously published, Chinese-specific diabetes CVD risk models by other groups 45,46 .…”

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“…Patient data was obtained through the Clinical Data Analysis and Reporting System (CDARS), a territory-wide electronic healthcare database managed by the Hong Kong Hospital Authority, which serves an estimated 90% of the population in Hong Kong. CDARS has previously been used extensively to conduct large population-based studies 19, 20 , including those on anticoagulation use 21, 22 .…”