The Modifying Effects of Adiposity on the Cardiovascular Saf
This study aimed to determine whether adiposity modified the effect on the cardiovascular safety of sulfonylureas as a first-line therapy compared with metformin among patients with type 2 diabetes.

Using the UK Clinical Practice Research Datalink, we conducted a cohort study among 13?862 new sulfonylurea users matched on body mass index (BMI) and propensity score, in a 1:1 ratio, to new metformin users. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) of major adverse cardiovascular events (MACE), individual components of MACE (myocardial infarction, ischemic stroke, cardiovascular mortality), and all-cause mortality, comparing use of sulfonylureas with use of metformin overall, and within BMI categories (less than?24.9?kg/m2, 25.0–29.9?kg/m2, more than?30?kg/m2).

-- Compared with metformin, sulfonylureas were not associated with an increased risk of MACE either overall or by BMI categories.

-- Similar findings were observed for myocardial infarction and ischemic stroke. In contrast, sulfonylureas were associated with an increased risk of cardiovascular mortality, primarily among obese patients, and not among normal-weight patients.

-- Similar results were observed for all-cause mortality, where an increased risk was observed among obese patients, but not normal-weight patients.

Conclusively, the findings of this study suggest that adiposity may have a modifying effect on the association between sulfonylureas and cardiovascular and all-cause mortality compared with metformin.