HealthDay News — Metformin is associated with reduced cardiovascular mortality compared with sulfonylureas, according to a large analysis published online in the Annals of Internal Medicine.

Shari Bolen, MD, MPH, assistant professor of medicine at the Case Western Reserve University’s Center for Health Care Research and Policy in Cleveland, and colleagues conducted the analysis, which included 204 studies involving 1.4 million people.

The researchers found that metformin reduced the risk of dying from heart attack and stroke by about 30% to 40% compared with sulfonylureas such as glibenclamide, glimepiride, glipizide, and tolbutamide.

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“The evidence supports metformin as first-line therapy for type 2 diabetes, given its relative safety and beneficial effects on hemoglobin A1c, weight, and cardiovascular mortality (compared with sulfonylureas),” the authors write.


  1. Maruthur NM, Tseng E, Hutfless S, et al. Diabetes Medications as Monotherapy of Metformin-Based Combination Therapy for Type 2 Diabetes: A Systematic Review and Meta-analysis. Ann Intern Med. 2016; doi: 10.7326/M15-2650