Impaired Fasting Glucose and Sulfonylureas Raise Heart Risk in Inflammatory Arthritis, reveals study

Results

Among a total follow-up duration of 119,571 patient-years, 934 patients (6.7%) had their first MACE. Some differences were found between patients with and without MACE:

• 19.4% of patients with MACE had IFG (5.6–6.9 mmol/l) at baseline, compared to 15.2% of non-MACE patients (p < 0.001)

• 17.6% of the MACE patients had fasting glucose ≥ 7 mmol/l, versus 8.1% without MACE (p < 0.001)

In a subgroup analysis of anti-diabetic therapy-naïve patients, prediabetic status (IFG) independently increased the risk of MACE:

• Hazard Ratio (HR) 2.43 (95% CI 1.97–2.99) in the C-reactive protein (CRP) model

• HR 2.54 (95% CI 1.50–7.71) in the erythrocyte sedimentation rate (ESR) model

In addition, among diabetic patients, sulfonylurea use was linked with a 55% higher risk of MACE with an:

• HR of 1.55 (95% CI 1.14–2.09) after other factors that influenced the risk were controlled

Investigators concluded that impaired fasting glucose and the use of sulfonylureas separately add to the risk of major cardiovascular events. These results identify the absolute need for enhanced cardiovascular risk assessment and individually appropriate management in IA patients, especially those with abnormal glucose metabolism. More stringent fasting glucose monitoring, sulfonylurea avoidance where possible, and a preference for cardiovascular protection in therapeutic choice may diminish somewhat the large cardiovascular risk burden of this at-risk population.

Reference:

Meng, H., So, H., Lam, S.H. et al. Impaired fasting glucose and sulfonylureas increased the risk of major cardiovascular events in patients with inflammatory arthritis. Diabetol Metab Syndr 17, 132 (2025). https://doi.org/10.1186/s13098-025-01689-6