Onoue Takeshi, Kang Yu, Lefebvre Bénédicte, Smith Amanda M, Denduluri Srinivas, Carver Joseph, Fradley Michael G, Chittams Jesse, Scherrer-Crosbie Marielle
Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Thalheimer Center for Cardio-Oncology, Division of Cardiology and Abramson Cancer Center, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
JACC CardioOncol. 2023 Aug 29;5(5):674-682. doi: 10.1016/j.jaccao.2023.05.013. eCollection 2023 Oct.
The prevention of heart failure (HF) is an important issue in patients treated with anthracyclines. Metformin, widely used to treat diabetes mellitus (DM), protects from anthracycline-induced cardiotoxicity in vitro and in animal models.
The aim of our study was to test the association of metformin with the occurrence of symptomatic HF in patients with DM receiving anthracyclines.
A total of 561 patients with DM received new anthracycline therapy between 2008 and 2021 in a tertiary care center; propensity score matching was used to compare patients with or without metformin treatment. The primary outcome was new onset symptomatic HF occurring within 1 year of the initiation of anthracyclines.
A total of 315 patients (65 ± 11 years of age, 33.7% male) were included. Patients with and without metformin were well matched for age, sex, type of cancer, medications, and cardiovascular risk factors. Six patients treated with metformin and 17 matched patients developed HF within 1 year of anthracycline initiation. The incidence of HF in patients treated with metformin was lower than patients without metformin within 1 year after anthracyclines (cumulative incidence: 3.6% vs 10.5%; = 0.022; HR: 0.35; 95% CI: 0.14-0.90; = 0.029). The use of metformin (HR: 0.71; 95% CI: 0.50-1.00; = 0.049), was also associated with lower mortality.
The use of metformin was associated with a lower incidence of HF and overall mortality in patients with DM receiving anthracyclines. Our findings should be further confirmed by randomized control trials.
在接受蒽环类药物治疗的患者中，预防心力衰竭（HF）是一个重要问题。二甲双胍广泛用于治疗糖尿病（DM），在体外和动物模型中可预防蒽环类药物引起的心脏毒性。
我们研究的目的是检验二甲双胍与接受蒽环类药物治疗的糖尿病患者发生症状性心力衰竭之间的关联。
2008年至2021年期间，共有561例糖尿病患者在一家三级医疗中心接受了新的蒽环类药物治疗；采用倾向评分匹配法比较接受或未接受二甲双胍治疗的患者。主要结局是在开始使用蒽环类药物后1年内发生的新发症状性心力衰竭。
共纳入315例患者（年龄65±11岁, 男性占33.7%）。接受和未接受二甲双胍治疗的患者在年龄、性别、癌症类型、药物治疗和心血管危险因素方面匹配良好。6例接受二甲双胍治疗的患者和17例匹配患者在开始使用蒽环类药物后1年内发生心力衰竭。在使用蒽环类药物后1年内，接受二甲双胍治疗的患者心力衰竭发生率低于未接受二甲双胍治疗的患者（累积发生率：3.6%对10.5%；P = 0.022；HR：0.35；95%CI：0.14 - 0.90；P = 0.029）。使用二甲双胍（HR：0.71；95%CI：0.50 - 1.00；P = 0.049）也与较低的死亡率相关。
在接受蒽环类药物治疗的糖尿病患者中，使用二甲双胍与较低的心力衰竭发生率和总体死亡率相关。我们的研究结果应通过随机对照试验进一步证实。
