Metformin treatment is associated with a low risk of mortality in diabetic patients with heart failure: a retrospective nationwide cohort study
Metformin treatment is associated with a low risk of mortality in diabetic patients with heart failure: a retrospective nationwide cohort study
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DOI：
10.1007/s00125-010-1906-6
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发表时间：
2010-12-01
期刊：
影响因子：
8.2
通讯作者：
Gislason, G. H.
中科院分区：
文献类型：
--
作者：
Andersson, C.;Olesen, J. B.;Gislason, G. H.
目的/假设二甲双胍治疗心力衰竭的安全性受到质疑，因为人们认为二甲双胍有危及生命的乳酸性酸中毒的风险，尽管最近的研究并未支持这种担忧。我们调查了与丹麦当前临床实践中使用的个体降糖治疗方案相关的全因死亡风险。方法确定了 1997 年至 2006 年首次因心力衰竭住院的所有年龄≥30 岁的患者，并随访至 2006 年底。接受二甲双胍、磺酰脲类和/或胰岛素治疗的患者被纳入其中，并被分配到单、双或三联治疗组。采用多变量Cox比例风险回归模型评估全因死亡风险。结果共纳入10,920例患者。中位观察时间为 844 天（四分位数范围 365-1,395 天）。总共有 6,187 名患者（57%）死亡。以磺脲类单药治疗为参考，不同治疗组的全因死亡率调整后风险比如下：二甲双胍 0.85 (95% CI 0.75-0.98，p=0.02)，二甲双胍+磺脲类 0.89 (95% CI 0.82-0.96，p=0.003)，二甲双胍+胰岛素 0.96 （95% CI 0.82-1.13，p=0.6），二甲双胍+胰岛素+磺酰脲类 0.94（95% CI 0.77-1.15，p=0.5），磺酰脲类+胰岛素 0.97（95% CI 0.86-1.08，p=0.5）和胰岛素 1.14（95% CI 1.06-1.20，p=0.0001）。结论/解释与磺酰脲类或胰岛素治疗相比，二甲双胍治疗合并心力衰竭的糖尿病患者死亡率风险较低。
Aims/hypothesis The safety of metformin in heart failure has been questioned because of a perceived risk of life-threatening lactic acidosis, though recent studies have not supported this concern. We investigated the risk of all-cause mortality associated with individual glucose-lowering treatment regimens used in current clinical practice in Denmark.Methods All patients aged >= 30 years hospitalised for the first time for heart failure in 1997-2006 were identified and followed until the end of 2006. Patients who received treatment with metformin, a sulfonylurea and/or insulin were included and assigned to mono-, bi- or triple therapy groups. Multivariable Cox proportional hazard regression models were used to assess the risk of all-cause mortality.Results A total of 10,920 patients were included. The median observational time was 844 days (interquartile range 365-1,395 days). In total, 6,187 (57%) patients died. With sulfonylurea monotherapy used as the reference, adjusted hazard ratios for all-cause mortality associated with the different treatment groups were as follows: metformin 0.85 (95% CI 0.75-0.98, p=0.02), metformin+sulfonylurea 0.89 (95% CI 0.82-0.96, p=0.003), metformin+insulin 0.96 (95% CI 0.82-1.13, p=0.6), metformin+insulin+sulfonylurea 0.94 (95% CI 0.77-1.15, p=0.5), sulfonylurea+insulin 0.97 (95% CI 0.86-1.08, p=0.5) and insulin 1.14 (95% CI 1.06-1.20, p=0.0001).Conclusions/interpretation Treatment with metformin is associated with a low risk of mortality in diabetic patients with heart failure compared with treatment with a sulfonylurea or insulin.