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Association of metformin with the mortality and incidence of cardiovascular events in patients with pre-existing cardiovascular diseases
  • +9
  • Tian Li,
  • Rui Providencia,
  • Wenhua Jiang,
  • Nan Mu,
  • Yishi Wang,
  • Xiaokang Li,
  • Yue Yin,
  • Manling Liu,
  • Lu Yu,
  • Chunhu Gu,
  • Alex Chia Yu Chang,
  • Heng Ma
Tian Li
Fourth Military Medical University

Corresponding Author:[email protected]

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Rui Providencia
Saint Bartholomew's Hospital Barts Heart Centre
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Wenhua Jiang
Fourth Military Medical University
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Nan Mu
Fourth Military Medical University
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Yishi Wang
Fourth Military Medical University
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Xiaokang Li
Fourth Military Medical University
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Yue Yin
Fourth Military Medical University
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Manling Liu
Fourth Military Medical University
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Lu Yu
Fourth Military Medical University
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Chunhu Gu
Fourth Military Medical University
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Alex Chia Yu Chang
Shanghai Jiao Tong University
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Heng Ma
Fourth Military Medical University
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Abstract

Background and Purpose Whereas whether metformin reduce all-cause, cardiovascular mortality, and incidence of cardiovascular events in patients with cardiac diseases remains inconclusive. Experimental Approach PubMed and Embase were searched up to May 2020 with a registration in PROSPERO (CRD42020189905) were collected. This article includes randomized controlled trials (RCT) and cohort studies. Hazard ratio (HR) with 95% CI was pooled across various trials by a random-effects model. Risk of bias was accounted as per Cochrane and Newcastle-Ottawa Scale (NOS) guidelines. Key Results This article enrolled 48 articles (1999-2020) for qualitative synthesis and identified 26 articles (33 studies in total, 61,704 patients) for final quantitative synthesis. Compared with non-metformin control, metformin is associated with reduced all-cause mortality (HR: 0.90; 95% CI: 0.83, 0.98; P = 0.01), cardiovascular mortality (HR: 0.89; 95% CI: 0.85, 0.94; P < 0.0001), incidence of coronary revascularization (HR: 0.79; 95% CI: 0.64, 0.98; P = 0.03), and heart failure (HR: 0.90; 95% CI: 0.87, 0.94; P < 0.0001) in patients with cardiac diseases, whereas metformin is not associated with reduced incidence of myocardial infarction (HR: 0.97; 95% CI: 0.80, 1.17; P = 0.73), angina (HR: 0.29; 95% CI: 0.04, 2.35; P = 0.25), and stroke (HR: 0.95; 95% CI: 0.78, 1.16; P = 0.59). Conclusion and Implications Metformin reduces all-cause mortality, cardiovascular mortality, incidence of coronary revascularization, and heart failure of patients with cardiac diseases, whereas metformin is not associated with reduced incidence of myocardial infarction, angina, and stroke.
Feb 2022Published in Drugs volume 82 issue 3 on pages 311-322. 10.1007/s40265-021-01665-0