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Metformin therapy in patients with diabetes mellitus is associated with a reduced risk of vasculopathy and cardiovascular mortality after heart transplantation.
Cardiovascular Diabetology ( IF 9.3 ) Pub Date : 2019-09-16 , DOI: 10.1186/s12933-019-0925-y Eilon Ram 1, 2 , Jacob Lavee 1, 2 , Alexander Tenenbaum 1, 2 , Robert Klempfner 1, 2 , Enrique Z Fisman 1, 2 , Elad Maor 1, 2 , Tal Ovdat 3 , Sergei Amunts 1, 2 , Leonid Sternik 1, 2 , Yael Peled 1, 2
Cardiovascular Diabetology ( IF 9.3 ) Pub Date : 2019-09-16 , DOI: 10.1186/s12933-019-0925-y Eilon Ram 1, 2 , Jacob Lavee 1, 2 , Alexander Tenenbaum 1, 2 , Robert Klempfner 1, 2 , Enrique Z Fisman 1, 2 , Elad Maor 1, 2 , Tal Ovdat 3 , Sergei Amunts 1, 2 , Leonid Sternik 1, 2 , Yael Peled 1, 2
Affiliation
BACKGROUND
Cardiac allograft vasculopathy (CAV) is a major cause of morbidity and mortality following heart transplantation (HT). Reduced cardiovascular mortality and morbidity have been reported in non-HT patients treated with metformin. Given the high prevalence of type 2 diabetes mellitus (T2DM) in HT patients, we investigated the association between metformin therapy and cardiovascular outcomes after HT.
METHODS
The study population comprised 103 DM patients who had undergone HT between 1994 and 2018 and were prospectively followed-up. We excluded from the study patients with type 1 diabetes mellitus. Fifty-five HT patients (53%) in the cohort were treated with metformin. Clinical data were recorded on prospectively designed forms. The primary outcomes included CAV, survival, and the combined end-point of CAV or cardiovascular mortality.
RESULTS
Kaplan-Meier survival analysis showed that the CAV rate at 20 years of follow-up was lower in DM patients treated with metformin than in those who were not (30 vs. 65%; log-rank p = 0.044). Similarly, the combined risk of CAV or cardiovascular mortality was lower in the metformin-treated patients than in those not receiving metformin (32 vs. 68%; log rank p = 0.01). Consistently, multivariate analysis adjusted for age and comorbidities showed that metformin therapy was independently associated with a significant 90% reduction (95% confidence interval 0.02-0.46, p = 0.003) in the risk for the development of CAV, and a 91% reduction (95% confidence interval 0.02-0.42; p = 0.003) in the risk for CAV or cardiovascular mortality.
CONCLUSIONS
In diabetic HT patients, metformin therapy is independently associated with a significant reduction in the long-term risk for CAV and the combined end-point of CAV or cardiovascular mortality after HT.
中文翻译：
糖尿病患者的二甲双胍治疗可减少心脏移植后血管病变和心血管疾病死亡的风险。
背景技术心脏同种异体移植血管病（CAV）是心脏移植（HT）后发病和死亡的主要原因。据报道，用二甲双胍治疗的非HT患者心血管疾病死亡率和发病率降低。鉴于HT患者的2型糖尿病（T2DM）患病率很高，我们调查了二甲双胍治疗与HT后心血管预后之间的关系。方法研究人群包括1994年至2018年接受过HT治疗的103名DM患者，并对其进行了前瞻性随访。我们从研究中排除了1型糖尿病患者。该队列中的55例HT患者（53％）接受了二甲双胍治疗。临床数据以前瞻性设计形式记录。主要结局包括CAV，生存率以及CAV合并终点或心血管疾病死亡率。结果Kaplan-Meier生存分析表明，接受二甲双胍治疗的DM患者在20年随访中的CAV率低于未接受二甲双胍的DM患者（30 vs. 65％；对数秩p = 0.044）。同样，用二甲双胍治疗的患者的CAV或心血管疾病死亡的综合风险要低于未接受二甲双胍的患者（32 vs. 68％； log rank p = 0.01）。一致地，针对年龄和合并症进行的多因素分析显示，二甲双胍治疗与CAV发生风险显着降低90％（95％置信区间0.02-0.46，p = 0.003）独立相关，而与CAV降低相关的则为91％（ 95％置信区间0.02-0.42； p = 0.003）的CAV或心血管疾病死亡风险。结论在糖尿病HT患者中，
更新日期：2019-09-16
中文翻译：
糖尿病患者的二甲双胍治疗可减少心脏移植后血管病变和心血管疾病死亡的风险。
背景技术心脏同种异体移植血管病（CAV）是心脏移植（HT）后发病和死亡的主要原因。据报道，用二甲双胍治疗的非HT患者心血管疾病死亡率和发病率降低。鉴于HT患者的2型糖尿病（T2DM）患病率很高，我们调查了二甲双胍治疗与HT后心血管预后之间的关系。方法研究人群包括1994年至2018年接受过HT治疗的103名DM患者，并对其进行了前瞻性随访。我们从研究中排除了1型糖尿病患者。该队列中的55例HT患者（53％）接受了二甲双胍治疗。临床数据以前瞻性设计形式记录。主要结局包括CAV，生存率以及CAV合并终点或心血管疾病死亡率。结果Kaplan-Meier生存分析表明，接受二甲双胍治疗的DM患者在20年随访中的CAV率低于未接受二甲双胍的DM患者（30 vs. 65％；对数秩p = 0.044）。同样，用二甲双胍治疗的患者的CAV或心血管疾病死亡的综合风险要低于未接受二甲双胍的患者（32 vs. 68％； log rank p = 0.01）。一致地，针对年龄和合并症进行的多因素分析显示，二甲双胍治疗与CAV发生风险显着降低90％（95％置信区间0.02-0.46，p = 0.003）独立相关，而与CAV降低相关的则为91％（ 95％置信区间0.02-0.42； p = 0.003）的CAV或心血管疾病死亡风险。结论在糖尿病HT患者中，
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