Key result
Among veterans with AAA, metformin-exposed diabetics had a lower risk of AAA surgery (HR 0.770; 95% CI 0.730-0.813) and death within 10 years (HR 0.877; 95% CI 0.855-0.899) compared to non-diabetics.
Why the study?
The study sought to examine the progression from abdominal aortic aneurysm diagnosis to surgery and death among diabetics with and without metformin exposure, as well as non-diabetics.
Does metformin exposure affect the risk of AAA surgery and death in diabetic patients with abdominal aortic aneurysm compared to unexposed diabetics and non-diabetics?
Cohort (n=123,440)
Does metformin exposure affect the risk of AAA surgery and death in diabetic patients with abdominal aortic aneurysm compared to unexposed diabetics and non-diabetics?
Hazard Ratio: 0.77 (95% CI 0.73–0.813)
In veterans with abdominal aortic aneurysm, diabetics not on metformin have the highest risk of death before and after surgery, whereas metformin use is associated with a lower risk of death in the first 10 years after diagnosis.
Should not yet change AAA management; hypothesis-generating for metformin's role, requiring RCTs for confirmation.
We sought to examine the progression from abdominal aortic aneurysm (AAA) diagnosis to surgery and death among diabetics with and without exposure to metformin as well as non-diabetics. We conducted a retrospective cohort study (January 2000 to July 2019) comparing 3 transitions (AAA surgery, death, and death after AAA surgery) among propensity score-matched metformin-exposed and unexposed diabetic veterans and non-diabetic veterans using the VA Informatics and Computing Infrastructure database. We fit an adjusted Cox proportional hazards model with transition-specific effects. There were 43,073 metformin-unexposed diabetics, 24,361 metformin-exposed diabetics and 56,006 non-diabetics. Compared with the non-diabetic cohort, both diabetic cohorts have a lower risk of surgery (no metformin (HR=0.740, 95% CI 0.706 to 0.776); with metformin (HR=0.770, 95% CI 0.730 to 0.813)). However, the non-metformin diabetic cohort has a higher risk of death (HR=1.024, 95% CI 1.004 to 1.045) and death after surgery (HR=1.086, 95% CI 1.013 to 1.165). The metformin-exposed diabetic cohort has a lower risk of death in the first 10 years after AAA diagnosis (HR=0.877, 95% CI 0.855 to 0.899), yet a higher risk of death 10 years after AAA diagnosis (HR=1.177, 95% CI 1.092 to 1.270) compared with non-diabetic cohort. Non-diabetics have the highest rate of AAA surgery compared with both diabetic cohorts. However, diabetics without metformin have the highest risk of death prior to, and after surgery. This research provides novel findings for patients diagnosed with AAA. The use of metformin after both AAA diagnosis and surgery should be further investigated.
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Sutton et al. (2020) conducted a cohort in Abdominal aortic aneurysm (n=123,440). Metformin vs. Non-diabetics and diabetics without metformin exposure was evaluated on AAA surgery (HR 0.770, 95% CI 0.730 to 0.813). Among veterans with AAA, metformin-exposed diabetics had a lower risk of AAA surgery (HR 0.770; 95% CI 0.730-0.813) and death within 10 years (HR 0.877; 95% CI 0.855-0.899) compared to non-diabetics.
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