Download PDF
Exp Clin Endocrinol Diabetes 2003; 111(6): 344-350
DOI: 10.1055/s-2003-42725
Article

J. A. Barth Verlag in Georg Thieme Verlag Stuttgart · New York

Influence of an Antidiabetic Treatment with Sulfonylurea Drugs on Long-Term Survival after Acute Myocardial Infarction in Patients with Type 2 Diabetes

The LAngendreer Myocardial Infarction and Blood Glucose in Diabetic Patients Assessment (LAMBDA)J. J. Meier 1 , 2 , S. Deifuß 1 , A. Klamann 1 , W. Schmiegel 1 , M. A. Nauck 1 , 2 , 3
  • 1Department of Medicine, Knappschafts-Krankenhaus, Ruhr-University, Bochum, Germany
  • 2Department of Medicine I, St. Josef-Hospital, Ruhr-University, Bochum, Germany
  • 3Diabeteszentrum Bad Lauterberg im Harz, Germany
Further Information

Publication History

Received: August 13, 2002 First decision: October 14, 2002

Accepted: January 10, 2003

Publication Date:
01 October 2003 (online)

Also available at
    Permissions and Reprints

Abstract

Introduction

Patients with type 2 diabetes show a significantly higher mortality after acute myocardial infarction than non-diabetic patients. The influence of sulfonylureas on the survival after acute myocardial infarction is still under debate.

Patients and Methods

Survival of 562 patients, consecutively admitted to an intensive care unit with the diagnosis acute myocardial infarction, was prospectively assessed for > 3 years. At the time of hospital admission, patients were grouped as (a) non-diabetic patients; (b) patients with newly diagnosed type 2 diabetes; (c) patients with known type 2 diabetes not treated with sulfonylureas and (d) patients with known type 2 diabetes treated with sulfonylureas. Survival-analysis was performed according to Kaplan-Meier.

Results

324 patients were non-diabetics, in 86 cases type 2 diabetes was newly diagnosed at the time of hospital admission, 77 patients with known diabetes had taken sulfonylureas (glibenclamide in all cases) prior to the acute myocardial infarction, 75 patients were on any other antidiabetic treatment. Long-term-survival was significantly shorter in patients with type 2 diabetes compared to the non-diabetic patients (p < 0.0001). However, no significant differences were observed between the patients with type 2 diabetes treated with sulfonylurea-drugs and those receiving any other antidiabetic treatment (p = 0.53)

Conclusions

An antidiabetic treatment with sulfonylurea-drugs prior to acute myocardial infarction does not have negative effects on the long-term survival. Larger prospective studies will be necessary to finally clarify this question.

Key words

Type 2 diabetes - sulfonylureas - myocardial infarction - ischemic preconditioning

References

  • 1 Ballagi-Pordany G, Koltai M Z, Aranyi Z, Pogatsa G. Direct effect of hopyglycemic sulphonylureas on the cardiovascular system of dogs.  Diabetes Res Clin Pract. 1991;  11 47-52
    CrossrefPubMedGoogle Scholar
  • 2 Brady P A, Terzic A. The sulfonylurea controversy: more questions from the heart.  J Am Coll Cardiol. 1998;  31 950-956
    CrossrefPubMedGoogle Scholar
  • 3 Cleveland J C, Meldrum D R, Cain B S, Banerjee A, Harken A H. Oral sulfonylurea hypoglycemic agents prevent ischemic preconditioning in human myocardium: two paradoxes revisited.  Circulation. 1997;  96 29-32
    CrossrefPubMedGoogle Scholar
  • 4 Collins R, Peto R, Baigent C, Sleight P. Aspirin, heparin and fibrinolytic therapy in suspected acute myocardial infarction.  N Engl J Med. 1997;  336 847-860
    CrossrefPubMedGoogle Scholar
  • 5 Engler R L, Yellon D M. Sulfonylurea KATP blockade in type 2 diabetes and preconditioning in cardiovascular disease: time for reconsideration.  Circulation. 1996;  94 2297-2301
    PubMedGoogle Scholar
  • 6 Garratt K N, Brady P A, Hassinger N L, Grill D E, Terzic A, Holmes D R. Sulfonylurea drugs increase early mortality in patients with diabetes mellitus after direct angioplasty for acute myocardial infarction.  J Am Coll Cardiol. 1999;  33 119-124
    CrossrefPubMedGoogle Scholar
  • 7 Groop L. Sulfonylureas in NIDDM.  Diabetes Care. 1992;  15 737-754
    PubMedGoogle Scholar
  • 8 Gross G, Auchampach J A. Blockade of ATP-sensitive potassium channels prevents myocardial preconditioning in dogs.  Circ Res. 1992;  70 223-233
    CrossrefPubMedGoogle Scholar
  • 9 Haffner S, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction.  N Engl J Med. 1998;  339 229-234
    CrossrefPubMedGoogle Scholar
  • 10 Halkin A, Roth A, Jonas M, Behar S. Sulfonylureas are not associated with increased mortality in diabetics treated with thrombolysis for acute myocardial infarction.  J Thromb Thrombolysis. 2001;  12 177-184
    CrossrefPubMedGoogle Scholar
  • 11 Hennekens C H, Albert C M, Godfried S L, Gaziano J M, Buring J E. Adjunctive drug therapy of acute myocardial infarction - evidence from clinical trials.  N Engl J Med. 1996;  335 1660-1667
    CrossrefPubMedGoogle Scholar
  • 12 Jarret R J, McCartney P, Keen H. The Bedford survey: Ten year mortality rates in newly diagnosed diabetics, borderline diabetics and normoglycaemic controls and risk indices for coronary heart disease in borderline diabetics.  Diabetologia. 1982;  22 79-85
    PubMedGoogle Scholar
  • 13 Keen H, Jarrett R J, McCartney P. The ten-year follow-up of the Bedford Survey (1962 - 72). Glucose tolerance and diabetes.  Diabetologia. 1982;  22 73-78
    PubMedGoogle Scholar
  • 14 Klamann A, Sarfert P, Schulte G, Launhardt V, Schmiegel W, Nauck M A. Myocardial infarction in diabetic versus non-diabetic subjects. Relation of survival and infarct size to therapy with sulfonylureas (Glibenclamide).  Eur Heart J. 2000;  21 220-229
    CrossrefPubMedGoogle Scholar
  • 15 Kondo T, Kubota I, Tachibana H, Yamaki M, Tomoike H. Glibenclamide attenuates peaked T wave in early phase of myocardial ischemia.  Cardiovasc Res. 1996;  31 683-687
    CrossrefPubMedGoogle Scholar
  • 16 Kubota I, Yamaki M, Shibata T, Ikeno E, Hosoya Y, Tomoike H. Role of ATP-sensitive K channel on ECG ST sehment elevation during a bout of myocardial ischemia: a study on epicardial mapping in dogs.  Circulation. 1993;  88 1845-1851
    PubMedGoogle Scholar
  • 17 Lebovitz H E, Melander A. Sulfonylureas: basic aspects and clinical use. Alberti KGMM, Zimmet P, DeFronzo RA, Keen H International Textbook of Diabetes Mellitus. Vol. 1. Chichester, UK; John Wiley & Sons Ltd 1997: 817-840
    Google Scholar
  • 18 Leibowitz G, Cerasi E. Sulphonylurea treatment of NIDDM patients with cardiovascular disease: a mixed blessing?.  Diabetologia. 1996;  39 503-514
    PubMedGoogle Scholar
  • 19 Meier J J, Deifuss S, Klamann A, Schmiegel W, Nauck M A. Influence of an antidiabetic treament with sulfonylurea drugs on long-term survival after myocardial infarction in type 2 diabetic patients (abstract).  Diabetologia. 2001;  44 (Suppl 1) A69
    PubMedGoogle Scholar
  • 20 Meier J J, Klamann A, Heimesaat M, Sarfert P, Schmiegel W, Nauck M A. Prädiktoren eines letalen Verlaufes von Myokardinfarkten bei Typ 2-Diabetikern.  Diabetes Stoffw. 2000;  9 149-155
    PubMedGoogle Scholar
  • 21 Meinert C L, Knatterud G L, Prout T E, Klimt C R, for the study Group U GDP. A study of the effects of hypoglycemic agents on vascular complications in patients with adult-onset diabetes.  Diabetes. 1970;  19 789-830
    PubMedGoogle Scholar
  • 22 Miettinen H, Lehto S, Salomaa V, Mähönen M, Niemelä M, Haffner S, Pyörälä K, Tuomiletho J. Impact of diabetes on mortality after the first myocardial infarction.  Diabetes Care. 1998;  21 69-75
    PubMedGoogle Scholar
  • 23 Mocanu M M, Maddock H L, Baxter G F, Lawrence C L, Standen N B, Yellon D M. Glimepiride, a novel sulfonylurea, does not abolish myocardial protection afforded by either ischemic preconditioning or diazoxide.  Circulation. 2001;  103 3111-3116
    PubMedGoogle Scholar
  • 24 Ovunc K. Effects of glimepiride, a K(ATP) channel blocker, on warm-up phenomenon in type II diabetic patients with chronic stable angina pectoris.  Clin Cardiol. 2000;  23 535-539
    PubMedGoogle Scholar
  • 25 Pogatsa G, Dubecz E. The direct effect of hypoglycaemic sulphonylureas on myocardial contractile force and arterial blood pressure.  Diabetologia. 1977;  13 515-519
    CrossrefPubMedGoogle Scholar
  • 26 Rytter L, Troelsen S, Beck-Nielsen H. Prevalence and mortality of acute myocardial infarction in patients with diabetes.  Diabetes Care. 1985;  8 230-234
    CrossrefPubMedGoogle Scholar
  • 27 Soler N G, Pentecost B L, Bennet M A, FitzGerald M G, Lamb P, Malins J M. Coronary care for myocardial infarction in diabetics.  Lancet. 1974;  1 475-477
    PubMedGoogle Scholar
  • 28 Tan B H, Wilson G L, Schaffer S W. Effect of tolbutamide on myocardial metabolism and mechanical performance on the diabetic rat.  Diabetes. 1984;  33 1138-1143
    PubMedGoogle Scholar
  • 29 The expert committee on the diagnosis and classification of diabetes mellitus . Report of the expert committee on the diagnosis and classification of diabetes mellitus.  Diabetes Care. 1997;  21 (Suppl 1) 5-22
    PubMedGoogle Scholar
  • 30 Tomai F, Crea F, Gaspardone A, Versaci F, De Paulis R, de Peppo P, Chiariello L, Gioffre P A. Ischemic preconditioning during coronary angioplasty is prevented by glibenclamide, a selective ATP-sensitive K+ channel blocker.  Circulation. 1994;  90 700-705
    PubMedGoogle Scholar
  • 31 Toombs C F, Moore T L, Shebuski R J. Limitation of infarct size in the rabbit by ischaemic preconditioning is reversilbe with glibenclamide.  Cardivasc Res. 1993;  27 617-622
    PubMedGoogle Scholar
  • 32 Prospective Diabetes Study Group U K(UKPDS). Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes.  Lancet. 1998;  352 837-853
    CrossrefPubMedGoogle Scholar
  • 33 Ulvenstam G, Aberg A, Bergstrand R, Johansson S, Pennert K, Vedin A, Wilhelmsen L, Wilhelmsson C. Long-term prognosis after myocardial infarction in men with diabetes.  Diabetes. 1985;  34 787-792
    PubMedGoogle Scholar

Prof. Dr. med. Michael Nauck

Diabetes-Zentrum
Bad Lauterberg

Kirchberg 21

37431 Bad Lauterberg

Germany

Phone: + 49 5524 81218

Fax: + 49 55 24 8 13 98

Email: m.nauck@diabeteszentrum.de