Endocrinology, Diabetes and Metabolism Institute, Cleveland Clinic, Cleveland, OH 44195, United States of America.
Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, United States of America.
J Diabetes Complications. 2022 Nov;36(11):108315. doi: 10.1016/j.jdiacomp.2022.108315. Epub 2022 Sep 24.
Type 2 diabetes (T2D) has a strong association with atrial fibrillation (AF) which increases risk of thromboembolic events, heart failure, and frequent hospitalizations. Metformin is the first-line medication for T2D with proposed anti-inflammatory, pro-metabolic, and cardio-protective benefits. Our objective was to investigate if initial therapy with metformin is associated with reduced incidence of AF in comparison to other non-insulin anti-hyperglycemic agents in patients with newly diagnosed T2D.
This retrospective cohort analysis included adults with a new diagnosis of T2D who were started on monotherapy (except insulin) between 2007 and 2017, without prior anti-hyperglycemic agent use, history of arrhythmias, or estimated GFR (eGFR) ≤ 30 ml/min. A multivariate analysis was performed using a fine-gray regression competing risk analysis to control for confounding variables after which pooled hazard ratios and 95 % confidence intervals were reported. Patients were followed until the end of study date, development of AF, addition of more anti-hyperglycemic agents, or death, whichever occurred first.
Among 4584 metformin initiators compared to 1080 non-metformin monotherapy initiators, 10-year cumulative incidence of AF in metformin group was 5.2 % as compared to 8.1 % with other agents which was not statistically significant. Competing risk analysis did not demonstrate reduced rates of AF with metformin use (HR 0.92, 95 % CI 0.69 to 1.21; P = 0.55). Increased age and the presence of congestive heart failure were associated with significantly higher risk of AF in both groups (HR: 1.29, 95 % CI: 1.21 to 1.37; P ≤ 0.001; HR: 2.73, 95 % CI: 1.62 to 4.61; P ≤ 0.001, respectively).
Initiation of metformin as a first line monotherapy for T2D, when compared to other non-insulin monotherapies, was not associated with decreased risk of developing AF in this retrospective observational study.
2 型糖尿病（T2D）与心房颤动（AF）密切相关，后者会增加血栓栓塞事件、心力衰竭和频繁住院的风险。二甲双胍是 T2D 的一线治疗药物，具有抗炎、促进代谢和心脏保护作用。我们的目的是研究与其他非胰岛素类降糖药物相比，初治 T2D 患者使用二甲双胍治疗是否与 AF 发生率降低相关。
这项回顾性队列分析纳入了 2007 年至 2017 年期间新诊断为 T2D 的接受单药治疗（不包括胰岛素）的成年人，这些患者之前未使用过降糖药物，也没有心律失常或估算肾小球滤过率（eGFR）≤30ml/min 的病史。采用精细灰色回归竞争风险分析对多变量进行分析，以控制混杂因素后报告合并危险比和 95%置信区间。患者随访至研究结束日期、发生 AF、添加更多降糖药物或死亡，以先发生者为准。
在 4584 名二甲双胍起始治疗者与 1080 名非二甲双胍单药起始治疗者中，10 年累积 AF 发生率在二甲双胍组为 5.2%，而在其他药物组为 8.1%，但差异无统计学意义。竞争风险分析显示，使用二甲双胍并不能降低 AF 的发生率（HR 0.92，95%CI 0.69 至 1.21；P=0.55）。在两组中，年龄较大和充血性心力衰竭的存在与 AF 风险显著增加相关（HR：1.29，95%CI：1.21 至 1.37；P≤0.001；HR：2.73，95%CI：1.62 至 4.61；P≤0.001）。
在这项回顾性观察研究中，与其他非胰岛素单药治疗相比，初治 T2D 患者使用二甲双胍作为一线单药治疗与 AF 风险降低无关。
