Metformin use and mortality in ambulatory patients with diabetes and heart failure.
Metformin use and mortality in ambulatory patients with diabetes and heart failure.
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DOI：
10.1161/circheartfailure.110.952556
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发表时间：
2011-01
期刊：
影响因子：
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通讯作者：
Deswal A
中科院分区：
文献类型：
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作者：
Aguilar D;Chan W;Bozkurt B;Ramasubbu K;Deswal A
尽管糖尿病和心力衰竭（HF）共同存在，但HF患者中糖尿病的最佳药物治疗尚未得到很好的研究。我们试图比较二甲双胍的使用与一组非卧床糖尿病合并心衰患者的临床结局之间的关系。使用倾向评分匹配的样本，我们研究了二甲双胍使用与死亡风险或住院风险之间的关系，研究对象为在退伍军人事务部医疗中心门诊治疗的6185例HF和糖尿病患者。在该队列中，1561例（25.2%）患者接受二甲双胍治疗。在2年的随访中，246例（15.8%）接受二甲双胍治疗的患者和1177例（25.5%）未接受二甲双胍治疗的患者发生死亡（p<0.001）。在倾向评分匹配分析（n=2874）中，232名（16.1%）接受二甲双胍的患者发生死亡，而285名（19.8%）未接受二甲双胍的患者发生死亡[风险比（HR）0.76，95%CI 0.63至0.92，p< 0.01）。在倾向评分匹配分析中，接受二甲双胍治疗的个体与未接受二甲双胍治疗的个体之间的HF住院率或总住院率无显著差异（分别为HR 0.93，95% CI 0.74 - 1.18和HR 0.94，95% CI 0.83-1.07）。二甲双胍治疗可降低糖尿病合并心力衰竭患者的死亡率。未来，前瞻性研究是必要的，以确定最佳的治疗糖尿病患者的HF。
Despite the common coexistence of diabetes and heart failure (HF), the optimal medial treatment of diabetes in HF patients has not been well studied. We sought to compare the association between metformin use and clinical outcomes in a cohort of ambulatory patients with diabetes and established HF. Using propensity-score matched samples, we examined the association between metformin use and the risk of death or risk of hospitalization in a national cohort of 6185 patients with HF and diabetes treated in ambulatory clinics at Veteran Affairs medical centers. In this cohort, 1561 (25.2%) patients were treated with metformin. At two years of follow-up, death occurred in 246 (15.8%) patients receiving metformin and in 1177 (25.5%) patients not receiving metformin (p<0.001). In the propensity-score matched analysis (n=2874), death occurred in 232 (16.1%) patients receiving metformin compared to 285 (19.8%) patients not receiving metformin [hazard ratio (HR) 0.76, 95% CI 0.63 to 0.92, p< 0.01). In propensity-score matched analyses, HF hospitalization or total hospitalization rates were not significantly different between individuals treated with metformin compared to those not treated with metformin (HR 0.93, 95% CI 0.74 to 1.18, and HR 0.94, 95% CI 0.83–1.07, respectively). Metformin therapy was associated with lower rates of mortality in ambulatory patients with diabetes and HF. Future, prospective studies are necessary to define the optimal therapy for diabetic patients with HF.