PMID- 31526382
OWN - NLM
STAT- MEDLINE
DCOM- 20200511
LR  - 20200511
IS  - 1475-2840 (Electronic)
IS  - 1475-2840 (Linking)
VI  - 18
IP  - 1
DP  - 2019 Sep 16
TI  - Metformin therapy in patients with diabetes mellitus is associated with a reduced 
      risk of vasculopathy and cardiovascular mortality after heart transplantation.
PG  - 118
LID - 10.1186/s12933-019-0925-y [doi]
LID - 118
AB  - BACKGROUND: Cardiac allograft vasculopathy (CAV) is a major cause of morbidity 
      and mortality following heart transplantation (HT). Reduced cardiovascular 
      mortality and morbidity have been reported in non-HT patients treated with 
      metformin. Given the high prevalence of type 2 diabetes mellitus (T2DM) in HT 
      patients, we investigated the association between metformin therapy and 
      cardiovascular outcomes after HT. METHODS: The study population comprised 103 DM 
      patients who had undergone HT between 1994 and 2018 and were prospectively 
      followed-up. We excluded from the study patients with type 1 diabetes mellitus. 
      Fifty-five HT patients (53%) in the cohort were treated with metformin. Clinical 
      data were recorded on prospectively designed forms. The primary outcomes included 
      CAV, survival, and the combined end-point of CAV or cardiovascular mortality. 
      RESULTS: Kaplan-Meier survival analysis showed that the CAV rate at 20 years of 
      follow-up was lower in DM patients treated with metformin than in those who were 
      not (30 vs. 65%; log-rank p = 0.044). Similarly, the combined risk of CAV or 
      cardiovascular mortality was lower in the metformin-treated patients than in 
      those not receiving metformin (32 vs. 68%; log rank p = 0.01). Consistently, 
      multivariate analysis adjusted for age and comorbidities showed that metformin 
      therapy was independently associated with a significant 90% reduction (95% 
      confidence interval 0.02-0.46, p = 0.003) in the risk for the development of CAV, 
      and a 91% reduction (95% confidence interval 0.02-0.42; p = 0.003) in the risk 
      for CAV or cardiovascular mortality. CONCLUSIONS: In diabetic HT patients, 
      metformin therapy is independently associated with a significant reduction in the 
      long-term risk for CAV and the combined end-point of CAV or cardiovascular 
      mortality after HT.
FAU - Ram, Eilon
AU  - Ram E
AUID- ORCID: 0000-0003-3292-821X
AD  - Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 
      52621, Ramat Gan, Israel.
AD  - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
FAU - Lavee, Jacob
AU  - Lavee J
AD  - Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 
      52621, Ramat Gan, Israel.
AD  - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
FAU - Tenenbaum, Alexander
AU  - Tenenbaum A
AD  - Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 
      52621, Ramat Gan, Israel.
AD  - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
FAU - Klempfner, Robert
AU  - Klempfner R
AD  - Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 
      52621, Ramat Gan, Israel.
AD  - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
FAU - Fisman, Enrique Z
AU  - Fisman EZ
AD  - Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 
      52621, Ramat Gan, Israel.
AD  - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
FAU - Maor, Elad
AU  - Maor E
AD  - Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 
      52621, Ramat Gan, Israel.
AD  - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
FAU - Ovdat, Tal
AU  - Ovdat T
AD  - Israeli Association for Cardiovascular Trials, Ramat Gan, Israel.
FAU - Amunts, Sergei
AU  - Amunts S
AD  - Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 
      52621, Ramat Gan, Israel.
AD  - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
FAU - Sternik, Leonid
AU  - Sternik L
AD  - Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 
      52621, Ramat Gan, Israel.
AD  - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
FAU - Peled, Yael
AU  - Peled Y
AD  - Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 
      52621, Ramat Gan, Israel. Yael.Peled-Potashnik@sheba.health.gov.il.
AD  - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 
      Yael.Peled-Potashnik@sheba.health.gov.il.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20190916
PL  - England
TA  - Cardiovasc Diabetol
JT  - Cardiovascular diabetology
JID - 101147637
RN  - 0 (Hypoglycemic Agents)
RN  - 9100L32L2N (Metformin)
SB  - IM
MH  - Adult
MH  - Cause of Death
MH  - Coronary Artery Disease/diagnosis/mortality/*prevention & control
MH  - Diabetes Mellitus, Type 2/diagnosis/*drug therapy/mortality
MH  - Female
MH  - Heart Failure/diagnosis/mortality/*surgery
MH  - Heart Transplantation/*adverse effects/mortality
MH  - Humans
MH  - Hypoglycemic Agents/adverse effects/*therapeutic use
MH  - Male
MH  - Metformin/adverse effects/*therapeutic use
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
PMC - PMC6747732
OTO - NOTNLM
OT  - Cardiac allograft vasculopathy
OT  - Cardiovascular mortality
OT  - Heart transplantation
OT  - Metformin
COIS- The authors declare that they have no competing interests.
EDAT- 2019/09/19 06:00
MHDA- 2020/05/12 06:00
PMCR- 2019/09/16
CRDT- 2019/09/19 06:00
PHST- 2019/08/13 00:00 [received]
PHST- 2019/09/06 00:00 [accepted]
PHST- 2019/09/19 06:00 [entrez]
PHST- 2019/09/19 06:00 [pubmed]
PHST- 2020/05/12 06:00 [medline]
PHST- 2019/09/16 00:00 [pmc-release]
AID - 10.1186/s12933-019-0925-y [pii]
AID - 925 [pii]
AID - 10.1186/s12933-019-0925-y [doi]
PST - epublish
SO  - Cardiovasc Diabetol. 2019 Sep 16;18(1):118. doi: 10.1186/s12933-019-0925-y.