PMID- 31815634
OWN - NLM
STAT- MEDLINE
DCOM- 20200518
LR  - 20221004
IS  - 1475-2840 (Electronic)
IS  - 1475-2840 (Linking)
VI  - 18
IP  - 1
DP  - 2019 Dec 9
TI  - Metformin use and cardiovascular outcomes after acute myocardial infarction in 
      patients with type 2 diabetes: a cohort study.
PG  - 168
LID - 10.1186/s12933-019-0972-4 [doi]
LID - 168
AB  - 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.
FAU - Bromage, Daniel I
AU  - Bromage DI
AUID- ORCID: 0000-0002-4243-5964
AD  - The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, 
      London, WC1E 6HX, UK.
AD  - School of Cardiovascular Medicine and Sciences, King's College London British 
      Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, 
      London, SE5 9NU, UK.
FAU - Godec, Tom R
AU  - Godec TR
AD  - The London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, 
      UK.
FAU - Pujades-Rodriguez, Mar
AU  - Pujades-Rodriguez M
AD  - Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, 
      LS2 9JL, UK.
FAU - Gonzalez-Izquierdo, Arturo
AU  - Gonzalez-Izquierdo A
AD  - Institute of Health Informatics, University College London, 222 Euston Road, 
      London, NW1 2DA, UK.
AD  - Health Data Research UK London, University College London, 222 Euston Road, 
      London, NW1 2DA, UK.
AD  - The National Institute for Health Research University College London Hospitals 
      Biomedical Research Centre, University College London, 222 Euston Road, London, 
      NW1 2DA, UK.
FAU - Denaxas, S
AU  - Denaxas S
AD  - Institute of Health Informatics, University College London, 222 Euston Road, 
      London, NW1 2DA, UK.
AD  - Health Data Research UK London, University College London, 222 Euston Road, 
      London, NW1 2DA, UK.
AD  - The National Institute for Health Research University College London Hospitals 
      Biomedical Research Centre, University College London, 222 Euston Road, London, 
      NW1 2DA, UK.
FAU - Hemingway, Harry
AU  - Hemingway H
AD  - Institute of Health Informatics, University College London, 222 Euston Road, 
      London, NW1 2DA, UK.
AD  - Health Data Research UK London, University College London, 222 Euston Road, 
      London, NW1 2DA, UK.
AD  - The National Institute for Health Research University College London Hospitals 
      Biomedical Research Centre, University College London, 222 Euston Road, London, 
      NW1 2DA, UK.
FAU - Yellon, Derek M
AU  - Yellon DM
AD  - The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, 
      London, WC1E 6HX, UK. d.yellon@ucl.ac.uk.
LA  - eng
GR  - 05/40/04/DH_/Department of Health/United Kingdom
GR  - MR/L002043/1/MRC_/Medical Research Council/United Kingdom
GR  - MR/K006584/1/MRC_/Medical Research Council/United Kingdom
GR  - RP-PG-0407-10314/DH_/Department of Health/United Kingdom
GR  - ARC_/Arthritis Research UK/United Kingdom
GR  - CSO_/Chief Scientist Office/United Kingdom
GR  - SGL020\1087/DH_/Department of Health/United Kingdom
GR  - CRUK_/Cancer Research UK/United Kingdom
GR  - 086091/Z/08/Z/WT_/Wellcome Trust/United Kingdom
GR  - BHF_/British Heart Foundation/United Kingdom
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20191209
PL  - England
TA  - Cardiovasc Diabetol
JT  - Cardiovascular diabetology
JID - 101147637
RN  - 0 (Hypoglycemic Agents)
RN  - 9100L32L2N (Metformin)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Cause of Death
MH  - Databases, Factual
MH  - Diabetes Mellitus, Type 2/diagnosis/*drug therapy/mortality
MH  - Disease Progression
MH  - England/epidemiology
MH  - Female
MH  - Humans
MH  - Hypoglycemic Agents/adverse effects/*therapeutic use
MH  - Incidence
MH  - Longitudinal Studies
MH  - Male
MH  - Metformin/adverse effects/*therapeutic use
MH  - Middle Aged
MH  - Myocardial Infarction/diagnosis/*epidemiology/mortality
MH  - Prospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
PMC - PMC6900858
OTO - NOTNLM
OT  - Acute myocardial infarction
OT  - Cardioprotection
OT  - Cohort studies
OT  - Metformin
OT  - Outcomes
OT  - Type 2 diabetes
COIS- The authors declare that they have no competing interests.
EDAT- 2019/12/10 06:00
MHDA- 2020/05/19 06:00
PMCR- 2019/12/09
CRDT- 2019/12/10 06:00
PHST- 2019/09/27 00:00 [received]
PHST- 2019/11/29 00:00 [accepted]
PHST- 2019/12/10 06:00 [entrez]
PHST- 2019/12/10 06:00 [pubmed]
PHST- 2020/05/19 06:00 [medline]
PHST- 2019/12/09 00:00 [pmc-release]
AID - 10.1186/s12933-019-0972-4 [pii]
AID - 972 [pii]
AID - 10.1186/s12933-019-0972-4 [doi]
PST - epublish
SO  - Cardiovasc Diabetol. 2019 Dec 9;18(1):168. doi: 10.1186/s12933-019-0972-4.