Department of Cardiology, Chair of Cardiology, Cardiac Surgery, and Vascular Diseases, Medical University of Lodz, Lodz, Poland.
Kardiol Pol. 2018;76(9):1336-1343. doi: 10.5603/KP.a2018.0127. Epub 2018 Jun 4.
Metformin is one of the antihyperglycaemic drugs, reducing the risk of major cardiovascular events, including fatal ones. Although it is formally contraindicated in moderate and severe functional stages of heart failure (HF), it is commonly used in patients with concomitant type 2 diabetes mellitus (T2DM).
We sought to evaluate the effect of metformin and T2DM on total mortality and hospitalisation rates in patients with HF.
This retrospective analysis included 1030 adult patients (> 18 years) with HF from the Polish section of the HF Long-Term Registry (enrolled between 2011 and 2014). Patients with T2DM (n = 350) were identified and divided into two groups: those receiving metformin and those not. Both groups were subjected to one-year follow-up.
Mean patient age was 65.3 ± 13.5 years, with the predominance of male sex (n = 726) and obesity (mean body mass index 30.3 ± 5.5 kg/m2) and mean left ventricular ejection fraction was 34.3% ± 14.1%. Among patients with T2DM (n = 350) only 135 (38.6%) were treated with metformin. During one-year follow-up, 128 patients with HF died, of whom 53 had T2DM (15.1% vs. 10.9%, hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.87-0.91, p = 0.045). Metformin was associated with a lower mortality rate compared to other antihyperglycaemic agents (9.6% vs. 18.6%, HR 0.85; 95% CI 0.81-0.89, p = 0.023). There were no significant differences in the hospitalisation rate, including that due to HF decompensation, among patients treated with metformin and the remainder (53.5% vs. 40.0%, respectively HR 0.93, 95% CI 0.82-1.04, p = 0.433).
Metformin treatment in patients with different degrees of HF and T2DM is associated with a reduction in mortality and does not affect the hospitalisation rate.
二甲双胍是一种降血糖药物，可降低包括致命事件在内的主要心血管事件的风险。尽管它在中度和重度心功能衰竭（HF）的功能阶段被正式禁用，但在伴有 2 型糖尿病（T2DM）的患者中通常仍会使用。
我们旨在评估二甲双胍和 T2DM 对 HF 患者的总死亡率和住院率的影响。
这项回顾性分析纳入了来自波兰 HF 长期登记处的 1030 名年龄>18 岁的 HF 成年患者（于 2011 年至 2014 年期间入组）。识别出 T2DM 患者（n=350）并将其分为两组：接受二甲双胍治疗的患者和未接受二甲双胍治疗的患者。两组均进行为期一年的随访。
患者平均年龄为 65.3±13.5 岁，男性（n=726）占多数，肥胖（平均体重指数为 30.3±5.5kg/m2），平均左心室射血分数为 34.3%±14.1%。在 T2DM 患者（n=350）中，仅 135 例（38.6%）接受了二甲双胍治疗。在一年的随访期间，128 例 HF 患者死亡，其中 53 例患有 T2DM（15.1%比 10.9%，风险比 [HR]0.89，95%置信区间 [CI]0.87-0.91，p=0.045）。与其他降糖药物相比，二甲双胍治疗与较低的死亡率相关（9.6%比 18.6%，HR0.85；95%CI0.81-0.89，p=0.023）。在接受二甲双胍治疗的患者和其余患者之间，包括 HF 失代偿所致住院率在内，无显著差异（分别为 53.5%和 40.0%，HR0.93，95%CI0.82-1.04，p=0.433）。
在不同程度 HF 和 T2DM 的患者中使用二甲双胍治疗与死亡率降低相关，并且不会影响住院率。
