Study paves the way for preventing sudden cardiac arrest

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A study comparing commonly used drugs for type 2 diabetes found that sulfonylurea drugs were associated with a reduced risk of cardiac arrest outside of the hospital compared to metformin. The research will be published today in the British Journal of Clinical Pharmacology and will be featured at EHRA 2021, an online scientific congress of the European Society of Cardiology (ESC).

The study was carried out as part of the European Sudden Cardiac Arrest Network (ESCAPE-NET), an EU-funded project with 16 partners, including the European Heart Rhythm Association (EHRA) of the ESC.

Dr. Hanno Tan, ESCAPE-NET project leader and cardiologist at Academic Medical Center in Amsterdam, The Netherlands, said: “Further research is needed to confirm the results and patients with diabetes should not change or discontinue their medication.”

Sudden cardiac arrest causes a fifth of deaths in developed countries. Most sudden cardiac arrests occur in the community. They are triggered by an unexpected arrhythmia that is fatal within minutes without treatment. ESCAPE-NET was set up to find the causes of these arrhythmias (e.g. medication) so that they can be prevented.

Diabetes is associated with an increased risk of sudden cardiac arrest, partly due to the increased presence and extent of coronary atherosclerosis5, and there is interest in minimizing this risk. Small studies have shown that some sulfonylurea drugs commonly used to control blood sugar levels in type 2 diabetes can reduce the risk of cardiac arrest outside the hospital, but the evidence is inconclusive.

This study looked at whether the use of sulfonylurea drugs (alone or in combination with metformin, another common anti-diabetic drug) was associated with a reduced risk of cardiac arrest compared to metformin alone.

The study enrolled 219 patients with diabetes who suffered cardiac arrest between 2005 and 2011 and were enrolled in the Amsterdam Resuscitation Studies (ARREST) ​​registry. Each patient was compared according to age and gender with up to five diabetes patients without cardiac arrest – in a total of 697 control patients.

The mean age in the case and control groups was 71 years and more than three-quarters were men. Compared to metformin alone, general use of sulfonylurea drugs was associated with a reduced risk of out-of-hospital cardiac arrest, with an odds ratio (OR) of 0.6 (95% confidence interval) [CI] 0.5-0.9). The drug use of sulfonylurea – both alone and in combination with metformin – was associated with a reduced risk of cardiac arrest compared to metformin monotherapy (OR 0.6).

Dr. Tan said, “Metformin is usually initial treatment, followed by a sulfonylurea drug when ineffective. This suggests that patients taking metformin have less advanced diabetes. This further supports the belief that that sulfonylurea drugs reduce the risk of cardiac arrest. ” . “

The researchers also compared individual sulfonylurea drugs and found that gliclazide was associated with a lower risk of cardiac arrest compared to glimepiride with an OR of 0.5.

Dr. Tan said, “The results of this study bring us one step closer to understanding how to avoid sudden cardiac arrest in the community. However, we need more studies to confirm our findings. One day we hope prevention through prescription of drugs to personalize accordingly to the genome of an individual. ”

Commonly used heart medication with an increased risk of sudden cardiac arrest

More information:
Sulfonylurea anti-diabetic drugs have been linked to lower risk of cardiac arrest outside the hospital: real-world data from a population-based study. Br J Clin Pharmacol. 2021. DOI: 10.1002 / BCP.14774. Provided by the European Society of Cardiology

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