Is there a potential association between spironolactone and the risk of new-onset diabetes in a cohort of older patients with heart failure?
Some evidence suggests that spironolactone may have a deleterious effect on glucose homeostasis. The objective of this study was to assess whether spironolactone use is associated with a higher risk of developing diabetes in a large cohort of patients with heart failure (HF).
Two Quebec government administrative databases were used to identify a cohort of hospitalized patients discharged between January 1995 and December 2009 with a primary discharge diagnosis of HF and without secondary discharge diagnosis of diabetes. Patients were categorized as new users of spironolactone and non-users. The primary outcome was defined as new-onset diabetes (NOD) during 5 years of follow-up and was ascertained using ICD codes for diabetes or use of hypoglycemic agents.
Among the 2974 patients that were included in the cohort analysis, 769 were given a new prescription of spironolactone. The incidence rate of NOD was similar among spironolactone users (5.0 per 100 person-years) and non-users (4.9 per 100 person-years). There was no significant association between the use of spironolactone and NOD in the crude, unadjusted model (hazard ratio (HR) 1.01; 95% confidence interval (CI) 0.80–1.28; p = 0.9217), and it remained unchanged in the adjusted Cox proportional hazard model (HR = 0.92; 95% CI = 0.72–1.18; p = 0.5227). The results were consistent with those observed in sensitivity analyses of a 1:3 propensity score-matched cohort (HR = 0.97; CI = 0.76–1.25; p = 0.8169).
We found no evidence supporting the claim that use of spironolactone is associated with a higher risk of diabetes among patients hospitalized for HF.
KeywordsSpironolactone Heart failure Diabetes mellitus Mineralocorticoid receptor Aldosterone
Réseau Québécois de Recherche sur Médicament (RQRM).
Compliance with ethical standards
Conflicts of interest
Sandra Korol: Sandra Korol received funding from Fonds de recherche du Québec – Santé (FRQS). Michel White: Dr. White received research grants from Bayer, Jenssen, Novartis, and Pfizer. He was a consultant for Jenssen USA and Arca Biopharma USA, and was a conference speaker for Bayer, Novartis, Pfizer, BMS, Servier, and BI. Simon de Denus: Dr. de Denus has received research grants or been a co-investigator on grants supported by AstraZeneca, Novartis, Roche and Pfizer. He has received speaker fees from Pfizer and consulting fees from Servier and Novartis. All other authors declare that they have no conflicts of interest.
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