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Metformin adherence and the risk of cardiovascular disease: a population-based cohort study
BACKGROUND: Metformin is a potent antiglycemic agent, but its importance has receded owing to the launch of novel antidiabetic medications. The benefit of metformin includes not only blood sugar control but also anti-inflammation, autophagy activation, and neuroprotection. This study investigated th...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10084537/ https://www.ncbi.nlm.nih.gov/pubmed/37051071 http://dx.doi.org/10.1177/20406223231163115 |
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author | Yu, Shun-Fan Hong, Chien-Tai Chen, Wan-Ting Chan, Lung Chien, Li-Nien |
author_facet | Yu, Shun-Fan Hong, Chien-Tai Chen, Wan-Ting Chan, Lung Chien, Li-Nien |
author_sort | Yu, Shun-Fan |
collection | PubMed |
description | BACKGROUND: Metformin is a potent antiglycemic agent, but its importance has receded owing to the launch of novel antidiabetic medications. The benefit of metformin includes not only blood sugar control but also anti-inflammation, autophagy activation, and neuroprotection. This study investigated the risk of cardiovascular disease (CVD) in people with type II diabetes mellitus (T2DM) who adhered to metformin after adding on a second-line antiglycemic agent. OBJECTIVES: The purpose of this study was to investigate the benefits of metformin in CVD prevention in patients with T2DM. DESIGN: We designed the study by comparing the incident rate of CVD events in patients with T2DM who received metformin continually and who ceased metformin during 2002–2014. METHODS: Medical information was obtained from the National Health Insurance Research Database, and patients with T2DM receiving second-line antiglycemic agents were categorized into metformin-adherent and nonadherent groups according to prescription claims. The study outcomes were the incidence of CVD hospitalization, including stroke (ischemic and hemorrhagic) and myocardial infarction (MI). RESULTS: A total of 31,384 patients with T2DM constituted the metformin-adherent group and were 1:1 matched to nonadherent patients. Metformin adherence was associated with a lower risk of hospitalization due to stroke [adjusted hazard ratio (aHR) = 0.51, 95% confidence interval (CI): 0.43–0.59, p < 0.001] and MI (aHR = 0.47, 95% CI: 0.43–0.53, p < 0.001). The risk reduction persisted in both ischemic and hemorrhagic strokes. Our subgroup analysis revealed that the protective effect on stroke and MI hospitalization persisted in metformin-adherent patients, both sexes, patients aged ⩽65 or >65 years, and patients with or without concurrent insulin treatment. CONCLUSIONS: This study revealed that metformin adherence in patients with T2DM who required a first-line treatment may reduce the risk of subsequent CVD. Despite the availability of numerous novel antiglycemic agents, metformin adherence by patients who require a combination of antiglycemic agents provides an additional benefit of CVD protection. |
format | Online Article Text |
id | pubmed-10084537 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-100845372023-04-11 Metformin adherence and the risk of cardiovascular disease: a population-based cohort study Yu, Shun-Fan Hong, Chien-Tai Chen, Wan-Ting Chan, Lung Chien, Li-Nien Ther Adv Chronic Dis Original Research BACKGROUND: Metformin is a potent antiglycemic agent, but its importance has receded owing to the launch of novel antidiabetic medications. The benefit of metformin includes not only blood sugar control but also anti-inflammation, autophagy activation, and neuroprotection. This study investigated the risk of cardiovascular disease (CVD) in people with type II diabetes mellitus (T2DM) who adhered to metformin after adding on a second-line antiglycemic agent. OBJECTIVES: The purpose of this study was to investigate the benefits of metformin in CVD prevention in patients with T2DM. DESIGN: We designed the study by comparing the incident rate of CVD events in patients with T2DM who received metformin continually and who ceased metformin during 2002–2014. METHODS: Medical information was obtained from the National Health Insurance Research Database, and patients with T2DM receiving second-line antiglycemic agents were categorized into metformin-adherent and nonadherent groups according to prescription claims. The study outcomes were the incidence of CVD hospitalization, including stroke (ischemic and hemorrhagic) and myocardial infarction (MI). RESULTS: A total of 31,384 patients with T2DM constituted the metformin-adherent group and were 1:1 matched to nonadherent patients. Metformin adherence was associated with a lower risk of hospitalization due to stroke [adjusted hazard ratio (aHR) = 0.51, 95% confidence interval (CI): 0.43–0.59, p < 0.001] and MI (aHR = 0.47, 95% CI: 0.43–0.53, p < 0.001). The risk reduction persisted in both ischemic and hemorrhagic strokes. Our subgroup analysis revealed that the protective effect on stroke and MI hospitalization persisted in metformin-adherent patients, both sexes, patients aged ⩽65 or >65 years, and patients with or without concurrent insulin treatment. CONCLUSIONS: This study revealed that metformin adherence in patients with T2DM who required a first-line treatment may reduce the risk of subsequent CVD. Despite the availability of numerous novel antiglycemic agents, metformin adherence by patients who require a combination of antiglycemic agents provides an additional benefit of CVD protection. SAGE Publications 2023-04-04 /pmc/articles/PMC10084537/ /pubmed/37051071 http://dx.doi.org/10.1177/20406223231163115 Text en © The Author(s), 2023 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Research Yu, Shun-Fan Hong, Chien-Tai Chen, Wan-Ting Chan, Lung Chien, Li-Nien Metformin adherence and the risk of cardiovascular disease: a population-based cohort study |
title | Metformin adherence and the risk of cardiovascular disease: a population-based cohort study |
title_full | Metformin adherence and the risk of cardiovascular disease: a population-based cohort study |
title_fullStr | Metformin adherence and the risk of cardiovascular disease: a population-based cohort study |
title_full_unstemmed | Metformin adherence and the risk of cardiovascular disease: a population-based cohort study |
title_short | Metformin adherence and the risk of cardiovascular disease: a population-based cohort study |
title_sort | metformin adherence and the risk of cardiovascular disease: a population-based cohort study |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10084537/ https://www.ncbi.nlm.nih.gov/pubmed/37051071 http://dx.doi.org/10.1177/20406223231163115 |
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