Endocrinol Metab > Epub ahead of print
DOI: https://doi.org/10.3803/EnM.2021.1046    [Epub ahead of print]
Published online October 14, 2021.
The Effects of Glucose Lowering Agents on the Secondary Prevention of Coronary Artery Disease in Patients with Type 2 Diabetes
Inha Jung1  , Hyemi Kwon1, Se Eun Park1, Kyung-Do Han2, Yong-Gyu Park3, Eun-Jung Rhee1  , Won-Young Lee1 
1Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
2Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
3Department of Biostatistics, Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Korea
Correspondence:  Eun-Jung Rhee, Tel: +82-2-2001-2485, Fax: +82-2-2001-2049, 
Email: hongsiri@hanmail.net
Won-Young Lee, Tel: +82-2-2001-2579, Fax: +82-2-2001-2049, 
Email: drlwy@hanmail.net
Received: 26 March 2021   • Revised: 27 July 2021   • Accepted: 6 August 2021
Patients with diabetes have a higher risk of requiring repeated percutaneous coronary intervention (PCI) than non-diabetic patients. We aimed to evaluate and compare the effects of anti-diabetic drugs on the secondary prevention of myocardial infarction among type 2 diabetes mellitus patients.
We analyzed the general health check-up dataset and claims data of the Korean National Health Insurance Service of 199,714 participants (age ≥30 years) who underwent PCIs between 2010 and 2013. Those who underwent additional PCI within 1 year of their first PCI (n=3,325) and those who died within 1 year (n=1,312) were excluded. Patients were classified according to their prescription records for glucose-lowering agents. The primary endpoint was the incidence rate of coronary revascularization.
A total of 35,348 patients were included in the study. Metformin significantly decreased the risk of requiring repeat PCI in all patients (adjusted hazard ratio [aHR], 0.77). In obese patients with body mass index (BMI) ≥25 kg/m2, patients treated with thiazolidinedione (TZD) exhibited a decreased risk of requiring repeat revascularization than those who were not treated with TZD (aHR, 0.77; 95% confidence interval, 0.63 to 0.95). Patients treated with metformin showed a decreased risk of requiring revascularization regardless of their BMI. Insulin, meglitinide, and alpha-glucosidase inhibitor were associated with increased risk of repeated PCI.
The risk of requiring repeat revascularization was lower in diabetic patients treated with metformin and in obese patients treated with TZD. These results suggest that physicians should choose appropriate glucose-lowering agents for the secondary prevention of coronary artery disease.
Key Words: Diabetes mellitus, Coronary artery disease, Secondary prevention, Percutaneous coronary intervention

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