Key result
Metformin linked to ~76% lower all-cause mortality and higher myocardial perfusion reserve in T2DM.
Why the study?
Patients with T2DM are at increased risk of cardiovascular disease, leading researchers to explore the association between metformin use, CMR-derived myocardial blood flow, myocardial perfusion reserve, and MACE.
Does metformin improve myocardial perfusion reserve and reduce all-cause mortality and MACE in patients with type 2 diabetes mellitus?
Cohort (n=572)
Yes
Does metformin improve myocardial perfusion reserve and reduce all-cause mortality and MACE in patients with type 2 diabetes mellitus?
Effect estimate: HR 0.24 (95% CI 0.08-0.70)
Absolute Event Rate: 2.3% vs 8.7%
p-value: p=0.009
In patients with type 2 diabetes mellitus, metformin use is associated with improved coronary microvascular function (higher myocardial perfusion reserve) and significantly lower all-cause mortality.
Metformin-associated perfusion and survival benefits in T2DM should not yet change practice; leaves open causality and MACE effects.
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.
No takes yet. Share an insight, caveat, or question.
Sharrack et al. (2024) conducted a cohort in Type 2 diabetes mellitus (n=572). Metformin vs. No metformin was evaluated on All-cause mortality (HR 0.24, 95% CI 0.08-0.70, p=0.009). Metformin use was associated with a 76% reduction in all-cause mortality (HR 0.24) and higher myocardial perfusion reserve compared to no metformin in patients with type 2 diabetes mellitus.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: