Risk of cardiovascular disease and all cause mortality among patients with type 2 diabetes prescribed oral antidiabetes drugs: retrospective cohort study using UK general practice research database

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dc.contributor.authorTzoulaki, I.en
dc.contributor.authorMolokhia, M.en
dc.contributor.authorCurcin, V.en
dc.contributor.authorLittle, M. P.en
dc.contributor.authorMillett, C. J.en
dc.contributor.authorNg, A.en
dc.contributor.authorHughes, R. I.en
dc.contributor.authorKhunti, K.en
dc.contributor.authorWilkins, M. R.en
dc.contributor.authorMajeed, A.en
dc.contributor.authorElliott, P.en
dc.date.accessioned2015-11-24T18:53:20Z
dc.date.available2015-11-24T18:53:20Z
dc.identifier.issn1756-1833-
dc.identifier.urihttps://olympias.lib.uoi.gr/jspui/handle/123456789/18542
dc.rightsDefault Licence-
dc.subjectAdministration, Oralen
dc.subjectAgeden
dc.subjectDiabetes Mellitus, Type 2/*drug therapy/mortalityen
dc.subjectDiabetic Angiopathies/*chemically induced/mortalityen
dc.subjectFemaleen
dc.subjectFractures, Bone/chemically induceden
dc.subjectHeart Failure/*chemically induceden
dc.subjectHumansen
dc.subjectHypoglycemic Agents/*administration & dosageen
dc.subjectMaleen
dc.subjectMetformin/administration & dosage/adverse effectsen
dc.subjectMiddle Ageden
dc.subjectMyocardial Infarction/*chemically induced/mortalityen
dc.subjectRetrospective Studiesen
dc.subjectRisk Factorsen
dc.subjectSulfonylurea Compounds/*administration & dosage/adverse effectsen
dc.subjectThiazolidinediones/administration & dosage/adverse effectsen
dc.titleRisk of cardiovascular disease and all cause mortality among patients with type 2 diabetes prescribed oral antidiabetes drugs: retrospective cohort study using UK general practice research databaseen
heal.abstractOBJECTIVE: To investigate the risk of incident myocardial infarction, congestive heart failure, and all cause mortality associated with prescription of oral antidiabetes drugs. DESIGN: Retrospective cohort study. SETTING: UK general practice research database, 1990-2005. PARTICIPANTS: 91,521 people with diabetes. MAIN OUTCOME MEASURES: Incident myocardial infarction, congestive heart failure, and all cause mortality. Person time intervals for drug treatment were categorised by drug class, excluding non-drug intervals and intervals for insulin. RESULTS: 3588 incident cases of myocardial infarction, 6900 of congestive heart failure, and 18,548 deaths occurred. Compared with metformin, monotherapy with first or second generation sulphonylureas was associated with a significant 24% to 61% excess risk for all cause mortality (P<0.001) and second generation sulphonylureas with an 18% to 30% excess risk for congestive heart failure (P=0.01 and P<0.001). The thiazolidinediones were not associated with risk of myocardial infarction; pioglitazone was associated with a significant 31% to 39% lower risk of all cause mortality (P=0.02 to P<0.001) compared with metformin. Among the thiazolidinediones, rosiglitazone was associated with a 34% to 41% higher risk of all cause mortality (P=0.14 to P=0.01) compared with pioglitazone. A large number of potential confounders were accounted for in the study; however, the possibility of residual confounding or confounding by indication (differences in prognostic factors between drug groups) cannot be excluded. CONCLUSIONS: Our findings suggest a relatively unfavourable risk profile of sulphonylureas compared with metformin for all outcomes examined. Pioglitazone was associated with reduced all cause mortality compared with metformin. Pioglitazone also had a favourable risk profile compared with rosiglitazone; although this requires replication in other studies, it may have implications for prescribing within this class of drugs.en
heal.accesscampus-
heal.fullTextAvailabilityTRUE-
heal.identifier.primary10.1136/bmj.b4731-
heal.identifier.secondaryhttp://www.ncbi.nlm.nih.gov/pubmed/19959591-
heal.identifier.secondaryhttp://www.bmj.com/highwire/filestream/399496/field_highwire_article_pdf/0-
heal.journalNameBMJen
heal.journalTypepeer-reviewed-
heal.languageen-
heal.publicationDate2009-
heal.recordProviderΠανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικήςel
heal.typejournalArticle-
heal.type.elΆρθρο Περιοδικούel
heal.type.enJournal articleen

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