期刊
CARDIOVASCULAR DIABETOLOGY
卷 18, 期 1, 页码 -出版社
BMC
DOI: 10.1186/s12933-019-0972-4
关键词
Acute myocardial infarction; Cardioprotection; Cohort studies; Metformin; Outcomes; Type 2 diabetes
资金
- MRC Clinical Research Training Fellowship [MR/L002043/1]
- NIHR
- Academy of Medical Sciences [SGL020\1087]
- Innovative Medicines Initiative-2 Joint Undertaking [116074]
- European Union
- EFPIA
- Health Data Research UK - UK Medical Research Council
- Engineering and Physical Sciences Research Council
- Economic and Social Research Council
- Department of Health and Social Care (England)
- Chief Scientist Office of the Scottish Government Health and Social Care Directorates
- Health and Social Care Research and Development Division (Welsh Government)
- Public Health Agency (Northern Ireland)
- British Heart Foundation
- Wellcome
- National Institute for Health Research [RP-PG-040710314]
- Wellcome Trust [086091/Z/08/Z, MR/K006584/1]
- Medical Research Council
- Arthritis Research UK
- Cancer Research UK
- Chief Scientist Office
- National Institute for Health Research
- National Institute for Social Care and Health Research
- National Institute for Health Research (NIHR) Biomedical Research Centre at University College London Hospitals
- ESRC [ES/L007517/1] Funding Source: UKRI
- MRC [MR/L002043/1, 1940103] Funding Source: UKRI
Background: The use of metformin after acute myocardial infarction (AMI) has been associated with reduced mortality in people with type 2 diabetes mellitus (T2DM). However, it is not known if it is acutely cardioprotective in patients taking metformin at the time of AMI. We compared patient outcomes according to metformin status at the time of admission for fatal and non-fatal AMI in a large cohort of patients in England. Methods: This study used linked data from primary care, hospital admissions and death registry from 4.7 million inhabitants in England, as part of the CALIBER resource. The primary endpoint was a composite of acute myocardial infarction requiring hospitalisation, stroke and cardiovascular death. The secondary endpoints were heart failure (HF) hospitalisation and all-cause mortality. Results: 4,030 patients with T2DM and incident AMI recorded between January 1998 and October 2010 were included. At AMI admission, 63.9% of patients were receiving metformin and 36.1% another oral hypoglycaemic drug. Median follow-up was 343 (IQR: 1-1436) days. Adjusted analyses showed an increased hazard of the composite endpoint in metformin users compared to non-users (HR 1.09 [1.01-1.19]), but not of the secondary endpoints. The higher risk of the composite endpoint in metformin users was only observed in people taking metformin at AMI admission, whereas metformin use post-AMI was associated with a reduction in risk of all-cause mortality (0.76 [0.62-0.93], P = 0.009). Conclusions: Our study suggests that metformin use at the time of first AMI is associated with increased risk of cardiovascular disease and death in patients with T2DM, while its use post-AMI might be beneficial. Further investigation in well-designed randomised controlled trials is indicated, especially in view of emerging evidence of cardioprotection from sodium-glucose co-transporter-2 (SGLT2) inhibitors.
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