Patients with diabetes who were treated with the popular oral medication metformin face a lower risk of heart attack, stroke or death than those taking sulfonylureas, another common option, according to a large, multiyear study.

About 8% of people in the United States have diabetes. Most have type 2 diabetes, which means they don't metabolize blood sugar (glucose) properly. Some people can reverse all signs of type 2 diabetes via weight loss, while others require medication to manage the condition.

Researchers who tracked hundreds of thousands of veterans with type 2 diabetes found that users of metformin (brand names include Glucophage and Fortamet) faced a "modest but clinically important" 21% lower risk of hospitalization because of cardiovascular complications than users of sulfonylureas (gluburide and glipizide).

Study lead author Christianne Roumie, MD, MPH, of the Geriatric Research Education Clinical Center at the Nashville Veterans Affairs Medical Center in Tennessee, cautioned, however, that they couldn't pinpoint whether metformin protects against heart issues or whether, by contrast, sufonylureas pose a specific threat to heart health. It's possible that both are true.

Although the researchers said the findings suggest metformin should be the preferred oral treatment for diabetes, they also stressed that it's not yet clear whether their findings would apply to women or other racial and ethnic groups, given that 97% of their study participants were men and 75% were white.

According to the American Diabetes Association, sulfonylurea drugs are insulin-production stimulants that have been in use since the 1950s. Metformin, also dating to the 1950s, works by lowering blood glucose levels.

Expert Comment

At least two-thirds of people with diabetes will die of heart disease, added Steven Nissen, MD, chairman of the department of cardiovascular medicine at the Cleveland Clinic in Ohio.

"The kind of information provided by a study like this on a diabetes drug's impact on heart disease is pretty important to have, when you think of it in that context," he said.

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