Metformin associates with higher myocardial perfusion reserve and survival in type 2 diabetes mellitus patients
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.
Authors
- Noor Sharrack (ORCID: https://orcid.org/0000-0001-5880-1722)
- James Moon (ORCID: https://orcid.org/0000-0001-8071-1491)
- John Pierre Greenwood (ORCID: https://orcid.org/0000-0002-2861-0914)
- Eylem Levelt (ORCID: https://orcid.org/0000-0002-3799-7102)
- Peter Kellman (ORCID: https://orcid.org/0000-0002-9875-6070)
- Gaurav Singh Gulsin (ORCID: https://orcid.org/0000-0002-1740-9270)
- Gerry P McCann (ORCID: https://orcid.org/0000-0002-5542-8448)
- Amrit Chowdhary (ORCID: https://orcid.org/0000-0002-2073-4138)
- Sharmaine Thirunavukarasu (ORCID: https://orcid.org/0000-0003-2535-8407)
- Robert Adam (ORCID: https://orcid.org/0000-0002-5018-1482)
- Peter Swoboda (ORCID: https://orcid.org/0000-0001-7162-7079)
- Jian L Yeo (ORCID: https://orcid.org/0000-0001-8324-4286)
- Chris P Gale (ORCID: https://orcid.org/0000-0003-4732-382X)
- Kristopher Knott (ORCID: https://orcid.org/0000-0003-1611-817X)
- Aldostefano Porcari
- Louise Brown (ORCID: https://orcid.org/0000-0002-1327-6482)
- Theresa Munyombwe (ORCID: https://orcid.org/0000-0002-1307-6691)
- Tushar Kotecha (ORCID: https://orcid.org/0000-0003-0059-4817)
- David L. Buckley (ORCID: https://orcid.org/0000-0001-6659-8365)
- Sven Plein (ORCID: https://orcid.org/0000-0002-0997-4384)
- Marianna Fontana
Institutions
- National Institutes of Health (US)
- St Bartholomew's Hospital (GB)
- University of Leeds (GB)
- University of Trieste (IT)
- University of Leicester (GB)
- Carol Davila University of Medicine and Pharmacy (RO)
- Leeds Teaching Hospitals NHS Trust (GB)
- The Royal Free Hospital (GB)
- Glenfield Hospital (GB)
- University Hospitals of Leicester NHS Trust (GB)
- National Heart, Lung, and Blood Institute (US)
- Azienda Sanitaria Universitaria Integrata di Trieste (IT)
- University College London (GB)
Publication Details
- Journal
- Scientific Reports
- Published
- 2024-11-08
- DOI
- https://doi.org/10.1038/s41598-024-77280-2
- Citations
- 3
- Primary Topic
- Diabetes Treatment and Management
- Type
- article
- Field-Weighted Citation Impact
- 1.07
Funders
- Wellcome Trust
- National Institute for Health and Care Research
- British Heart Foundation
- University College London
- Rural Development Administration
- Barts Health NHS Trust