Tolbutamide, smoking, and cardiac arrhythmia. A case report

Abstract

RECENTLY reported analyses of the mortality data of the University Group Diabetes Program (UGDP) study¹have prompted a reassessment of the role of oral hypoglycemic agents and other factors in ischemic heart disease in patients with diabetes. We describe a patient in whom the occurrence of premature ventricular contractions appeared to be associated with the combination of cigarette smoking and long-term treatment with tolbutamide. <h3>Report of a Case</h3> A 58-year-old woman was admitted to the Clinical Research Center as a volunteer subject in a continuing study of the pharmacogenetics of tolbutamide metabolism.^2,3She gave a reliable medical history of mild glucose intolerance and hypertension since 1968 but volunteered no complaints referable to these problems. The glucose intolerance was established by an oral glucose tolerance test (OGTT) in 1968, and repeated testing by her private physician in 1973 again showed blood glucose levels in the diabetic range. In addition,