Metformin-inclusive Therapy Reduces the Risk of Stroke in Patients with Diabetes: A 4-Year Follow-up Study
Metformin-inclusive Therapy Reduces the Risk of Stroke in Patients with Diabetes: A 4-Year Follow-up Study
复制标题
DOI：
10.1016/j.jstrokecerebrovasdis.2013.09.001
复制
发表时间：
2014-02-01
影响因子：
2.5
通讯作者：
Kao, Chung-Lan
中科院分区：
文献类型：
--
作者：
Cheng, Yuan-Yang;Leu, Hsin-Bang;Kao, Chung-Lan
二甲双胍是糖尿病患者常用的口服降糖药。虽然过去的研究已经证明了二甲双胍对心血管风险和相关死亡率的保护作用，但二甲双胍预防中风的证据仍然不足且相互矛盾。所有病例随访4年，追踪其脑卒中发生率。结果，3999例糖尿病患者中有701例（17.5%）在未使用二甲双胍的情况下发生卒中，而10857例使用二甲双胍的患者中有994例（9.2%）发生卒中。Cox比例风险回归分析显示，二甲双胍的卒中风险比（HR）为0.383。在调整了患者的年龄、性别、高血压、房颤、高脂血症、冠状动脉疾病以及包括抗血小板、香豆素、他汀类药物和雌激素使用在内的药物后，HR仍为0.468。进一步的分层分析显示，二甲双胍对卒中高危患者具有更强的保护作用。因此，根据我们的研究，在考虑卒中预防时，糖尿病患者口服降糖药应优先使用二甲双胍。
Metformin is a kind of oral hypoglycemic agents commonly prescribed to patients with diabetes mellitus. Although past studies had proven its protective effect on cardiovascular risk and related mortality, the evidence of metformin on stroke prevention was still insufficient and conflicting. Our study randomly selected 14,856 patients with diabetes from the database provided by the Taiwan National Health Research Institute, and 2 cohorts were formulated according to whether metformin was in the prescription record. All cases were followed up for 4 years to track their stroke incidence. As a result, 701 (17.5%) of 3999 diabetic patients had stroke without metformin use, whereas 994 (9.2%) of 10,857 patients had stroke with metformin use. Cox proportional hazard regressions showed that the stroke hazard ratio (HR) of metformin was .383. After adjustment for the patients' age, gender, hypertension, atrial fibrillation, hyperlipidemia, coronary artery disease, and medications including antiplate-lets, coumadin, statin, and estrogen use, the HR was still .468. Further stratified analysis revealed that metformin had more protective effect in the patients with higher risk of stroke. Therefore, metformin should be placed in priority when prescribing oral hypoglycemic agents for diabetic patients when considering stroke prevention according to our study.