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158-OR: Major Adverse Cardiovascular Events for Kidney Disease Patients Treated with Metformin or Sulfonylurea

2019; American Diabetes Association; Volume: 68; Issue: Supplement_1 Linguagem: Inglês

10.2337/db19-158-or

1939-327X

Christianne L. Roumie, Jonathan Chipman, Jea Young Min, Adriana M. Hung, Amber J. Hackstadt, Robert A. Greevy, Carlos G. Grijalva, Tom A. Elasy, Marie R. Griffin,

Pharmacology and Obesity Treatment

Background: Safety concerns limit metformin use in kidney disease. We compared major adverse cardiovascular events (MACE) for metformin or sulfonylureas users with reduced glomerular filtration rate (GFR). Methods: A retrospective cohort combined Veterans Administration, Medicare, and National Death Index databases. Metformin or sulfonylurea users were followed from renal threshold (GFR <60 ml/min or creatinine 1.4/1.5 [female, male] mg/dL) until MACE, treatment change, loss to follow-up, non-cardiovascular death or study end. MACE included myocardial infarction, stroke, transient ischemic attack hospitalization or cardiovascular death. The analysis compared MACE hazard for metformin vs. sulfonylurea users in a matched weighted cohort accounting for competing risks of non-persistence or non-cardiovascular death. Results: There were 67752 and 28976 persistent metformin and sulfonylurea users who reached renal threshold. The weighted cohort included 24683 metformin vs. 24801 sulfonylurea patients; 98% male; 82% white, median age 70 years (62.8, 77.8). Median GFR was 56 ml/min [51.6, 58.2] and HbA1c 6.6% [6.1, 7.1]. Metformin users had lower cause specific hazard of MACE vs. sulfonylurea (adjusted HR 0.81 [0.75, 0.87]). Subgroup results were similar by age, race and GFR. Conclusion: Compared to sulfonylureas, metformin use in patients with reduced GFR is associated with lower MACE risk. Disclosure C. Roumie: None. J.J. Chipman: None. J. Min: None. A.M. Hung: None. A.J. Hackstadt: None. R.A. Greevy: None. C.G. Grijalva: None. T. Elasy: None. M.R. Griffin: None. Funding U.S. Department of Veterans Affairs (CX000570-06)