Metformin associates with higher myocardial perfusion reserve and survival in type 2 diabetes mellitus patients
Year: 2024
Type: article
Study design: Observational Study
Abstract: Metformin is an antihyperglycemic used to treat type 2 diabetes mellitus (T2DM). Patients with T2DM are at increased risk of cardiovascular disease. We explored the association between metformin use and cardiovascular magnetic resonance (CMR) derived stress myocardial blood flow (MBF), myocardial perfusion reserve (MPR) and major adverse cardiovascular events (MACE; all cause death, MI, stroke, heart failure hospitalisation and coronary revascularisation) in patients with T2DM. Multi-centre study of patients with T2DM, and healthy controls, underwent quantitative myocardial perfusion CMR using an artificial intelligence supported process. Multivariable regression analysis, and cox proportional hazard models of propensity score weighted patients quantified associations between metformin use, MBF, MPR, all cause death and MACE. Analysis included 572 patients with T2DM (68% prescribed metformin) with median follow-up 851 days (IQR 935 - 765). Metformin use was associated with an increase of MPR of 0.12 [0.08-0.40], p = 0.004. There were 82 MACE events (14.3%) including 25 (4.4%) deaths of which 16 were in those not prescribed metformin (8.7%), compared to 9 in patients prescribed metformin (2.3%): adjusted hazard ratio 0.24 (95% CI 0.08-0.70, p = 0.009). MACE events were similar between groups. This multicentre, inverse probability weighting propensity score analysis study showed that in patients with T2DM, metformin use is associated with higher MPR and improved all cause survival.
Source: Scientific Reports
Authors: Noor Sharrack, Kristopher D. Knott, Gaurav S. Gulsin, Tushar Kotecha, Louise A. E. Brown, Jian L. Yeo, Aldostefano Porcari, Robert D. Adam, Sharmaine Thirunavukarasu, Amrit Chowdhary, Eylem Levelt, James C. Moon, Gerry P. McCann, Marianna Fontana, Peter Kellman, Theresa Munyombwe, Chris P. Gale, David L. Buckley, John P. Greenwood, Peter P. Swoboda, Sven Plein
Institutions: University of Leeds, St Bartholomew's Hospital, University College London, University of Leicester, Glenfield Hospital, University Hospitals of Leicester NHS Trust, NIHR Leicester Biomedical Research Centre, The Royal Free Hospital, University of Trieste, Azienda sanitaria universitaria Giuliano Isontina, Carol Davila University of Medicine and Pharmacy, National Institutes of Health, National Heart, Lung, and Blood Institute, Leeds Teaching Hospitals NHS Trust
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,590
Awards: G1526879960, G223159513, Myocardial energy starvation and ketone metabolism in patients with type 2 diabetes, G27403434, Myocardial energy starvation and ketone metabolism in patients with type 2 diabetes, The BHF Chair of Cardiovascular Imaging, Heart failure in type 2 diabetes: improving diagnosis and management in a multi-ethnic population., G3449402819, G3460009072, G4445566864, G5127990099, G5424470881, G6929902608, G7272929574, G7739656807, G8928633937
OpenAlex ID: W4404183252