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Metformin use and cardiovascular outcomes after acute myocardial infarction in patients with type 2 diabetes: a cohort study

Bromage, DI; Godec, TR; Pujades-Rodriguez, M; Gonzalez-Izquierdo, A; Denaxas, S; Hemingway, H; Yellon, DM; (2019) Metformin use and cardiovascular outcomes after acute myocardial infarction in patients with type 2 diabetes: a cohort study. Cardiovascular Diabetology , 18 , Article 168. 10.1186/s12933-019-0972-4. Green open access

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Abstract

BACKGROUND: The use of metformin after acute myocardial infarction (AMI) has been associated with reduced mortal‑ ity 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 compos‑ ite 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 frst AMI is associated with increased risk of car‑ diovascular disease and death in patients with T2DM, while its use post-AMI might be benefcial. Further investigation in well-designed randomised controlled trials is indicated, especially in view of emerging evidence of cardioprotec‑ tion from sodium-glucose co-transporter-2 (SGLT2) inhibitors

Type: Article
Title: Metformin use and cardiovascular outcomes after acute myocardial infarction in patients with type 2 diabetes: a cohort study
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1186/s12933-019-0972-4
Publisher version: https://doi.org/10.1186/s12933-019-0972-4
Language: English
Additional information: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Keywords: Acute myocardial infarction, Cardioprotection, Cohort studies, Metformin, Outcomes, Type 2 diabetes
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Pre-clinical and Fundamental Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics > Clinical Epidemiology
URI: https://discovery.ucl.ac.uk/id/eprint/10088085
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