| Autor: |
Richardson TL Jr; Veteran Administration Tennessee Valley VA Health Care System Geriatric Research Education Clinical Center (GRECC) Nashville TN.; Department of Medicine Vanderbilt University Medical Center Nashville TN., Hackstadt AJ; Veteran Administration Tennessee Valley VA Health Care System Geriatric Research Education Clinical Center (GRECC) Nashville TN.; Department of Biostatistics Vanderbilt University School of Medicine Nashville TN., Hung AM; Veteran Administration Tennessee Valley VA Health Care System Geriatric Research Education Clinical Center (GRECC) Nashville TN.; Department of Medicine Vanderbilt University Medical Center Nashville TN., Greevy RA; Veteran Administration Tennessee Valley VA Health Care System Geriatric Research Education Clinical Center (GRECC) Nashville TN.; Department of Biostatistics Vanderbilt University School of Medicine Nashville TN., Grijalva CG; Veteran Administration Tennessee Valley VA Health Care System Geriatric Research Education Clinical Center (GRECC) Nashville TN.; Department of Health Policy Vanderbilt University Medical Center Nashville TN., Griffin MR; Veteran Administration Tennessee Valley VA Health Care System Geriatric Research Education Clinical Center (GRECC) Nashville TN.; Department of Health Policy Vanderbilt University Medical Center Nashville TN., Elasy TA; Veteran Administration Tennessee Valley VA Health Care System Geriatric Research Education Clinical Center (GRECC) Nashville TN.; Department of Medicine Vanderbilt University Medical Center Nashville TN., Roumie CL; Veteran Administration Tennessee Valley VA Health Care System Geriatric Research Education Clinical Center (GRECC) Nashville TN.; Department of Medicine Vanderbilt University Medical Center Nashville TN.; Department of Health Policy Vanderbilt University Medical Center Nashville TN. |
| Abstrakt: |
Background Metformin and sulfonylurea are commonly prescribed oral medications for type 2 diabetes mellitus. The association of metformin and sulfonylureas on heart failure outcomes in patients with reduced estimated glomerular filtration rate remains poorly understood. Methods and Results This retrospective cohort combined data from National Veterans Health Administration, Medicare, Medicaid, and the National Death Index. New users of metformin or sulfonylurea who reached an estimated glomerular filtration rate of 60 mL/min per 1.73 m 2 or serum creatinine of 1.5 mg/dL and continued metformin or sulfonylurea were included. The primary outcome was hospitalization for heart failure. Echocardiogram reports were obtained to determine each patient's ejection fraction (EF) (reduced EF <40%; midrange EF 40%-49%; ≥50%). The primary analysis estimated the cause-specific hazard ratios for metformin versus sulfonylurea and estimated the cumulative incidence functions for heart failure hospitalization and competing events. The weighted cohort included 24 685 metformin users and 24 805 sulfonylurea users with reduced kidney function (median age 70 years, estimated glomerular filtration rate 55.8 mL/min per 1.73 m 2 ). The prevalence of underlying heart failure (12.1%) and cardiovascular disease (31.7%) was similar between groups. There were 16.9 (95% CI, 15.8-18.1) versus 20.7 (95% CI, 19.5-22.0) heart failure hospitalizations per 1000 person-years for metformin and sulfonylurea users, respectively, yielding a cause-specific hazard of 0.85 (95% CI, 0.78-0.93). Among heart failure hospitalizations, 44.5% did not have echocardiogram information available; 29.3% were categorized as reduced EF, 8.9% as midrange EF, and 17.2% as preserved EF. Heart failure hospitalization with reduced EF (hazard ratio, 0.79; 95% CI, 0.67-0.93) and unknown EF (hazard ratio, 0.84; 95% CI 0.74-96) were significantly lower in metformin versus sulfonylurea users. Conclusions Among patients with type 2 diabetes mellitus who developed worsening kidney function, persistent metformin compared with sulfonylurea use was associated with reduced heart failure hospitalization. |
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