Cedars Sinai Medical Center, Los Angeles, CA, USA.
J Card Fail. 2010 Mar;16(3):200-6. doi: 10.1016/j.cardfail.2009.10.022. Epub 2009 Nov 14.
Although 25% to 44% of patients with heart failure (HF) have diabetes mellitus (DM), the optimal treatment regimen for HF patients with DM is uncertain. We investigated the association between metformin therapy and outcomes in a cohort of advanced, systolic HF patients with DM.
Patients with DM and advanced, systolic HF (n = 401) were followed at a single university HF center between 1994 and 2008. The cohort was divided into 2 groups based on the presence or absence of metformin therapy. The cohort had a mean age of 56 +/- 11 years, left ventricular ejection fraction (LVEF) of 24 +/- 7%, with 42% being New York Heart Association (NYHA) III and 45% NYHA IV. Twenty-five percent (n = 99) were treated with metformin therapy. The groups treated and not treated with metformin were similar in terms of age, sex, baseline LVEF, medical history, and baseline glycosylated hemoglobin. Metformin-treated patients had a higher body mass index, lower creatinine, and were less often on insulin. One-year survival in metformin-treated and non-metformin-treated patients was 91% and 76%, respectively (RR = 0.37, CI 0.18-0.76, P = .007). After multivariate adjustment for demographics, cardiac function, renal function, and HF medications, metformin therapy was associated with a nonsignificant trend for improved survival.
In patients with DM and advanced, systolic HF who are closely monitored, metformin therapy appears to be safe. Prospective studies are needed to determine whether metformin can improve HF outcome.
尽管有 25%至 44%的心衰（HF）患者患有糖尿病（DM），但 DM 合并 HF 患者的最佳治疗方案仍不确定。我们研究了二甲双胍治疗与伴有 DM 的晚期收缩性 HF 患者结局之间的相关性。
1994 年至 2008 年间，在一家大学 HF 中心对患有 DM 和晚期收缩性 HF（n = 401）的患者进行了随访。该队列根据是否存在二甲双胍治疗分为两组。该队列的平均年龄为 56 ± 11 岁，左心室射血分数（LVEF）为 24 ± 7%，其中 42%为纽约心脏协会（NYHA）III 级，45%为 NYHA IV 级。25%（n = 99）接受了二甲双胍治疗。接受和未接受二甲双胍治疗的两组在年龄、性别、基线 LVEF、病史和基线糖化血红蛋白方面相似。接受二甲双胍治疗的患者体重指数更高、肌酐水平更低、且更常使用胰岛素。接受二甲双胍治疗和未接受二甲双胍治疗的患者的 1 年生存率分别为 91%和 76%（RR = 0.37，95%CI 0.18-0.76，P =.007）。对人口统计学、心脏功能、肾功能和 HF 药物进行多变量调整后，二甲双胍治疗与生存改善的趋势呈非显著相关。
在接受密切监测的伴有 DM 和晚期收缩性 HF 的患者中，二甲双胍治疗似乎是安全的。需要前瞻性研究来确定二甲双胍是否可以改善 HF 结局。
