Xu Zhicheng, Zhang Haidong, Wu Chenghui, Zheng Yuxiang, Jiang Jingzhou
Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China.
Department of Nephrology, Peking University Third Hospital, Bejing, China.
Front Cardiovasc Med. 2022 Sep 23;9:944902. doi: 10.3389/fcvm.2022.944902. eCollection 2022.
The cardiovascular protection effect of metformin on patients with type 2 diabetes mellitus (T2DM) remains inconclusive. This systemic review and meta-analysis were to estimate the effect of metformin on mortality and cardiovascular events among patients with T2DM.
A search of the Pubmed and EMBASE databases up to December 2021 was performed. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled by a random-effects model with an inverse variance method.
A total of 39 studies involving 2473009 T2DM patients were adopted. Compared to non-metformin therapy, the use of metformin was not significantly associated with a reduced risk of major adverse cardiovascular event (MACE) (HR = 1.06, 95%CI 0.91-1.22; = 82%), hospitalization (HR = 0.85, 95%CI 0.64-1.13; = 98%), heart failure (HR = 0.86, 95%CI 0.60-1.25; = 99%), stroke (HR = 1.16, 95%CI 0.88-1.53; = 84%), and risk of AMI (HR = 0.88, 95%CI 0.69-1.14; = 88%) in T2DM patients. Metformin was also not associated with significantly lowered risk of MACE compared to dipeptidyl peptidase-4 inhibitor (DPP-4i) in T2DM patients (HR = 0.95, 95%CI 0.73-1.23; = 84%).
The effect of metformin on some cardiovascular outcomes was not significantly better than the non-metformin therapy or DPP-4i in T2DM patients based on observational studies.
二甲双胍对2型糖尿病（T2DM）患者的心血管保护作用尚无定论。本系统评价和荟萃分析旨在评估二甲双胍对T2DM患者死亡率和心血管事件的影响。
检索截至2021年12月的Pubmed和EMBASE数据库。采用随机效应模型和逆方差法汇总调整后的风险比（HR）和95%置信区间（CI）。
共纳入39项研究，涉及2473009例T2DM患者。与非二甲双胍治疗相比，使用二甲双胍与T2DM患者主要不良心血管事件（MACE）风险降低无显著相关性（HR = 1.06，95%CI 0.91 - 1.22；I² = 82%）、住院风险降低无显著相关性（HR = 0.85，95%CI 0.64 - 1.13；I² = 98%）、心力衰竭风险降低无显著相关性（HR = 0.86，95%CI 0.60 - 1.25；I² = 99%）、中风风险降低无显著相关性（HR = 1.16，95%CI 0.88 - 1.53；I² = 84%）以及急性心肌梗死风险降低无显著相关性（HR = 0.88，95%CI 0.69 - 1.14；I² = 88%）。在T2DM患者中，与二肽基肽酶 - 4抑制剂（DPP - 4i）相比，二甲双胍也未显示出与MACE风险显著降低相关（HR = 0.95，95%CI 0.73 - 1.23；I² = 84%）。
基于观察性研究，在T2DM患者中，二甲双胍对某些心血管结局的影响并不显著优于非二甲双胍治疗或DPP - 4i。
