Abstract | BACKGROUND: Animal studies showed that the use of metformin after myocardial infarction (MI) resulted in a protective effect on cardiac myocytes. In this study, we examined the effect of metformin in patients with diabetes mellitus (DM) on left ventricular ejection fraction (LVEF) and post-MI mortality. METHODS: We reviewed charts of patients with MI admitted to the UAMS medical center. Baseline characteristics and 12-month follow up data were collected. Patients were classified into three groups: Control group- no DM (n = 464), Metformin group- DM + MI (n = 88) and No- Metformin group- DM + MI (n = 168). First, we compared Metformin and No- Metformin groups to the Control group. Second, we performed propensity-score matching in patients with DM, and compared Metformin to No- Metformin groups. RESULTS: All-cause 30-day and 12-month mortality was significantly higher in the No- Metformin group compared to controls (13.5 vs 9.3% p = 0.03 at 30 days, 23.7 vs 15.9 % p = 0.03 at 12 months). However, all-cause 30-day and 12-month mortality were similar in the Controls and Metformin group (9.3 vs 6.8 % p = 0.93 at 30 days, 15.9 vs 11.4 % p = 0.97 at 12 months). Mean LVEF on presentation (45 % in the three groups) and at follow up (47.84, 46.38 and 43.62 % in Control, Metformin, and No- Metformin groups, respectively) were not statistically different. There were no significant differences in regard to re-hospitalization, re-intervention, new stroke, CHF development, new MI, or identifiable arrhythmias. Metformin was an independent predictor of lower 30-day and 12-month all-cause mortality in patients with DM (HR 0.25, p = 0.02 and HR 0.32, p = 0.01, respectively). In the matched analysis, 30-day all-cause mortality was significantly higher in the No- Metformin compared to the Metformin group (21.1 vs 8.8 %, p = 0.05). However the difference in 12-month all-cause mortality did not reach statistical significance (24.6 vs 15.8 %, p = 0.15). CONCLUSION: This proof-of-concept study shows that use of metformin in patients with DM is associated with lower 30-day all-cause mortality and tendency for a lower 12-month all-cause mortality following MI without discernible improvement in LVEF.
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Authors | Amjad Abualsuod, Joshua J Rutland, Thomas E Watts, Summit Pandat, Robert Delongchamp, Jawahar L Mehta |
Journal | Cardiovascular drugs and therapy
(Cardiovasc Drugs Ther)
Vol. 29
Issue 3
Pg. 265-75
(Jun 2015)
ISSN: 1573-7241 [Electronic] United States |
PMID | 26068409
(Publication Type: Journal Article)
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Chemical References |
- Hypoglycemic Agents
- Metformin
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Topics |
- Case-Control Studies
- Cause of Death
- Diabetes Complications
(complications, drug therapy, mortality, physiopathology)
- Female
- Humans
- Hypoglycemic Agents
(pharmacology, therapeutic use)
- Male
- Metformin
(pharmacology, therapeutic use)
- Middle Aged
- Myocardial Infarction
(complications, mortality, physiopathology)
- Stroke Volume
(drug effects)
- Ventricular Function, Left
(drug effects)
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