TERISA: Angina Burden Differs With Diabetes Drug Class

Different classes of glucose-lowering medications appear to be associated with varying angina burden in patients with type 2 diabetes and stable coronary artery disease (CAD), according to new research presented at the American Heart Association’s Scientific Sessions 2014.

Specifically, the researchers found that patients taking sulfonylureas or insulin may have more angina and use more nitroglycerin than those not taking sulfonylureas or insulin. Conversely, patients taking metformin did not have a significantly different angina burden than those not taking the drug.

“There is ongoing concern regarding the safety of sulfonylureas in patients with cardiovascular disease, with several plausible mechanisms by which sulfonylureas might adversely affect CV risk and disease. These data increment such concerns to some degree by our demonstrated association of sulfonylureas with higher angina burden — a finding that resonates with prior observations of sulfonylureas having adverse effects on angina,” said study investigator Darren K. McGuire, MD, Professor of Medicine at the University of Texas Southwestern Medical Center in Dallas.

He said there is a “warm-up” phenomenon for patients with angina. If a patient with angina exercises, rests and exercises again, the second episode of exercise is commonly associated with angina occurring at a higher myocardial workload/level of exercise. That effect is attenuated by sulfonylureas, according to Dr. McGuire.

In addition, he said patients undergoing angioplasty with multiple balloon inflations tend to have less discomfort and less ST segment change with each subsequent inflation attenuated by sulfonylureas.

“So, these are just some historical correlates making our observational finding plausible and possibly could add to considerations regarding sulfonylurea prescription in patients with angina,” Dr. McGuire told Endocrinology Advisor.

He said different classes of diabetes medications have been associated with varying risks for myocardial infarction (MI) and CV death. However, Dr. McGuire said their associations with angina severity have not been studied. 

The TERISA trial (Type 2 Diabetes Evaluation of Ranolazine in Subjects With Chronic Stable Angina) enrolled patients with type 2 diabetes with stable angina from 14 countries from 2011 to 2012. The patients completed an electronic daily diary at baseline documenting weekly angina frequency and nitroglycerin use.