(Dept) Imaging Research, Baker Heart and Diabetes Institute, PO Box 6492, 75 Commercial Road, Melbourne, VIC, 3004, Australia.
School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
Cardiovasc Diabetol. 2020 Aug 5;19(1):124. doi: 10.1186/s12933-020-01100-w.
Observational series suggest a mortality benefit from metformin in the heart failure (HF) population. However, the benefit of metformin in HF with preserved ejection fraction (HFpEF) has yet to be explored. We performed a systematic review and meta-analysis to identify whether variation in EF impacts mortality outcomes in HF patients treated with metformin.
MEDLINE and EMBASE were searched up to October 2019. Observational studies and randomised trials reporting mortality in HF patients and the proportion of patients with an EF > 50% at baseline were included. Other baseline variables were used to assess for heterogeneity in treatment outcomes between groups. Regression models were used to determine the interaction between metformin and subgroups on mortality.
Four studies reported the proportion of patients with a preserved EF and were analysed. Metformin reduced mortality in both preserved or reduced EF after adjustment with HF therapies such as angiotensin converting enzyme inhibitors (ACEi) and beta-blockers (β = - 0.2 [95% CI - 0.3 to - 0.1], p = 0.02). Significantly greater protective effects were seen with EF > 50% (p = 0.003). Metformin treatment with insulin, ACEi and beta-blocker therapy were also shown to have a reduction in mortality (insulin p = 0.002; ACEi p < 0.001; beta-blocker p = 0.017), whereas female gender was associated with worse outcomes (p < 0.001).
Metformin treatment is associated with a reduction in mortality in patients with HFpEF.
观察性研究系列表明，二甲双胍可降低心力衰竭（HF）患者的死亡率。然而，HF 合并射血分数保留（HFpEF）患者中二甲双胍的益处尚未得到探索。我们进行了系统评价和荟萃分析，以确定 EF 的变化是否会影响接受二甲双胍治疗的 HF 患者的死亡率结局。
检索 MEDLINE 和 EMBASE 数据库，截至 2019 年 10 月。纳入报道 HF 患者死亡率和基线时 EF 值＞50%的患者比例的观察性研究和随机试验。使用其他基线变量评估治疗结局在组间的异质性。回归模型用于确定二甲双胍和亚组对死亡率的相互作用。
有 4 项研究报告了 EF 值保留的患者比例，并进行了分析。调整 HF 治疗（如血管紧张素转换酶抑制剂[ACEi]和β受体阻滞剂[β]）后，二甲双胍可降低 EF 保留或降低的患者的死亡率（β=−0.2[95%CI：−0.3 至−0.1]，p=0.02）。EF 值＞50%时，保护作用更为显著（p=0.003）。二甲双胍联合胰岛素、ACEi 和β受体阻滞剂治疗也可降低死亡率（胰岛素 p=0.002；ACEi p＜0.001；β受体阻滞剂 p=0.017），而女性性别与较差的结局相关（p＜0.001）。
二甲双胍治疗与 HFpEF 患者死亡率降低相关。
