Document Detail

Effect of Metformin on mortality in patients with heart failure and type 2 diabetes mellitus.
MedLine Citation:
PMID:  20854965     Owner:  NLM     Status:  MEDLINE    
Type 2 diabetes mellitus (DM) plus chronic heart failure (CHF) is a common but lethal combination and therapeutic options are limited. Metformin is perceived as being relatively contraindicated in this context, although mounting evidence indicates that it may be beneficial. This study was carried out to investigate the use of metformin therapy for treating patients with DM and CHF in a large population-based cohort study. The Health Informatics Centre-dispensed prescribing database for the population of Tayside, Scotland (population ∼400,000) was linked to the Diabetes Audit and Research in Tayside Scotland (DARTS) information system. Patients with DM and incident CHF from 1994 to 2003 receiving oral hypoglycemic agents but not insulin were identified. Cox regression was used to assess differences in all-cause mortality rates between patients prescribed metformin and patients prescribed sulfonylureas with adjustment for co-morbidities and other therapies. Four hundred twenty-two study subjects (mean ± SD 75.4 ± 0.5 years of age, 46.2% women) were identified: metformin monotherapy (n = 68, mean age 75.5 ± 1.1 years, 48.5% women), sulfonylurea monotherapy (n = 217, mean age 76.7 ± 0.7 years, 45.2% women), and combination (n = 137, mean age, 73.4 ± 0.7 years, 46.7% women). Fewer deaths occurred in metformin users, alone or in combination with sulfonylureas, compared to the sulfonylurea monotherapy cohort at 1 year (0.59, 95% confidence interval 0.36 to 0.96) and over long-term follow up (0.67, 95% confidence interval 0.51 to 0.88). In conclusion, this large observational data suggest that metformin may be beneficial in patients with CHF and DM. These findings need to be verified by a prospective clinical trial.
Josie M M Evans; Alex S F Doney; Matlooba A AlZadjali; Simon A Ogston; John R Petrie; Andrew D Morris; Allan D Struthers; Aaron K F Wong; Chim C Lang
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  106     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-21     Completed Date:  2010-10-26     Revised Date:  2011-10-19    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1006-10     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
Department of Nursing and Midwifery, University of Stirling, Stirling, United Kingdom.
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MeSH Terms
Diabetes Complications / drug therapy,  mortality*
Diabetes Mellitus, Type 2 / drug therapy*
Heart Failure / drug therapy,  mortality*
Hypoglycemic Agents / therapeutic use*
Metformin / therapeutic use*
Treatment Outcome
Grant Support
PG/06/143/21897//British Heart Foundation
Reg. No./Substance:
0/Hypoglycemic Agents; 657-24-9/Metformin
Comment In:
Rev Clin Esp. 2011 Sep;211(8):427-8

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