Pro- and antiarrhythmic actions of sulfonylureas: Mechanistic and clinical evidence Journal Article


Authors: Leonard, C. E.; Hennessy, S.; Han, X.; Siscovick, D. S.; Flory, J. H.; Deo, R.
Article Title: Pro- and antiarrhythmic actions of sulfonylureas: Mechanistic and clinical evidence
Abstract: Sulfonylureas are the most commonly used second-line drug class for treating type 2 diabetes mellitus (T2DM). While the cardiovascular safety of sulfonylureas has been examined in several trials and nonrandomized studies, little is known of their specific effects on sudden cardiac arrest (SCA) and related serious arrhythmic outcomes. This knowledge gap is striking, because persons with DM are at increased risk of SCA. In this review, we explore the influence of sulfonylureas on the risk of serious arrhythmias, with specific foci on ischemic preconditioning, cardiac excitability, and serious hypoglycemia as putative mechanisms. Elucidating the relationship between individual sulfonylureas and serious arrhythmias is critical, especially as the diabetes epidemic intensifies and SCA incidence increases in persons with diabetes. An increase in the incidence of SCA among persons with DM represents a major public health concern. Given this, it may be prudent to tailor prescribing to minimize SCA risk; a potential approach could include the optimization of oral antidiabetic drug therapy. Sulfonylureas remain the most commonly used second-line class for treating T2DM. The impact of an individual sulfonylurea on SCA risk may be driven by its ability to influence cardiac excitability, ischemic preconditioning, and/or serious hypoglycemia (among other mechanisms). A few small experimental and observational studies in humans suggest that glyburide reduces ventricular arrhythmias of varying clinical consequence; this putative effect requires rigorous examination. © 2017 Elsevier Ltd
Keywords: epidemiology; sudden cardiac death; diabetes mellitus type 2; sulfonylurea compounds; katp channels; cardiac arrhythmias
Journal Title: Trends in Endocrinology and Metabolism
Volume: 28
Issue: 8
ISSN: 1043-2760
Publisher: Elsevier Inc.  
Date Published: 2017-08-01
Start Page: 561
End Page: 586
Language: English
DOI: 10.1016/j.tem.2017.04.003
PROVIDER: scopus
PMCID: PMC5522643
PUBMED: 28545784
DOI/URL:
Notes: Review -- Export Date: 1 November 2017 -- Source: Scopus
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  1. James H Flory
    35 Flory