Metformin Tops Sulfonylureas for Heart Health

The diabetes drug metformin[1] offers more heart benefits than medicines in the sulfonylurea[2] class, according to new research from Vanderbilt University. Cardiovascular disease is the leading cause of death in those with diabetes, with more than two-thirds of people with the condition dying of heart disease or stroke[3].

To compare the effects of metformin (brand name Glucophage and others) and sulfonylureas (glyburide [Diabeta, Glynase, Micronase], glipizide (Glucotrol), glipizide extended-release [Glucotrol XL], glimepiride [Amaryl]) on cardiovascular outcomes such as heart attack[4], stroke, and death, researchers looked at the charts of more than 250,000 veterans receiving health care at Veterans Health Administration hospitals across the United States. All subjects had Type 2 diabetes[5], and all had been started on either metformin or a sulfonylurea — either glyburide or glipizide, in this case of this study — for their condition. Roughly 155,000 took metformin, while approximately 100,000 were on a sulfonylurea.


After reviewing about a year’s worth of data on each participant, the researchers discovered that those who had been prescribed metformin had a lower risk of heart attack, stroke, and death than those who were prescribed a sulfonylurea, with those on metformin facing a 21% lower risk of being hospitalized due to a cardiovascular condition.

“We demonstrated that for every 1,000 patients who are using metformin for a year, there are two fewer heart attacks, strokes or deaths compared with patients who use sulfonylureas. I think this reinforces the recommendation that metformin should be used as the first medication to treat diabetes” noted lead author Christianne L. Roumie, MD, MPH[6].

The researchers noted that they could not determine whether metformin offers heart benefits or whether sulfonylureas pose a specific heart risk, adding that both could be possible. Limitations of the study include that subjects were not compared to a control group that was not taking oral medicines, and that 97% of the participants were males and 75% were white (meaning that researchers do not know whether the findings apply to women and racial minorities).

For more information, read the article “Popular Diabetes Meds Put to the Test,”[7] or see the study’s abstract[8] in the Annals of Internal Medicine. And to learn more about metformin, see our many pieces[9] on the medicine.

  1. metformin:
  2. sulfonylurea:
  3. stroke:
  4. heart attack:
  5. Type 2 diabetes:
  6. noted lead author Christianne L. Roumie, MD, MPH:
  7. “Popular Diabetes Meds Put to the Test,”:
  8. study’s abstract:
  9. see our many pieces:

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Diane Fennell: Diane Fennell has been an editor at Diabetes Self-Management magazine since 2003. She is currently the Editorial Director. (Diane Fennell is not a medical professional.)

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