Metformin treatment is associated with a low risk... : Diabetologia (original) (raw)

Metformin treatment is associated with a low risk of mortality in diabetic patients with heart failure

a retrospective nationwide cohort study

C. Andersson
J. B. Olesen
P. R. Hansen
P. Weeke
M. L. Norgaard
C. H. Jørgensen
T. Lange
S. Z. Abildstrøm
T. K. Schramm
A. Vaag
L. Køber
C. Torp-Pedersen
G. H. Gislason

Diabetologia

(

)

2546

2553

December 2010

| DOI: 10.1007/s00125-010-1906-6

Abstract

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.