January 10, 2020
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Metformin after ACS limits repeat CVD episodes in type 2 diabetes

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Metformin may help adults with type 2 diabetes avoid additional cardiovascular disease events after an initial episode of acute coronary syndrome, or ACS, according to findings published in the Journal of Diabetes and its Complications.

“Patients with type 2 diabetes had higher incidence of recurrent CVD events compared with patients without diabetes. Glycemic control levels at admission did not affect the recurrence in patients with type 2 diabetes,” Tadashi Takeuchi, MD, of the Keio University Graduate School of Medicine in Tokyo, and colleagues wrote. “Among the type 2 diabetes group, patients receiving metformin during the acute phase of their ACS event showed a significantly lower incidence of recurrent CVD compared with those who did not receive metformin.”

Takeuchi and colleagues used medical records from St. Luke’s International Hospital in Tokyo for 569 adults who experienced ACS for the first time (mean age, 63.7 years; 17.2% women) to identify medication use and additional CVD events, such as cardiac death, myocardial infarction and ischemic stroke, during a mean 4.2 years of follow-up.

Among the 198 patients with type 2 diabetes, 10.6% had cardiac death, 4% experienced an MI and 4.5% had an ischemic stroke (P = .008) vs. 1.6% with cardiac death (P < .001), 0.8% with MI and 1.1% with ischemic stroke (P = .008) among those without diabetes.

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Metformin may help adults with type 2 diabetes avoid additional cardiovascular disease events after an initial episode of acute coronary syndrome, or ACS.

The researchers noted that “there was no significant difference in the risk for recurrent CVD events by HbA1c levels.”

Among those prescribed diabetes drugs, 32.8% used metformin, 44.4% used thiazolidines and 30.8% used sulfonylureas, according to the researchers. Metformin use was associated with a 77% decrease in recurrent CVD risk vs. no metformin use (HR = 0.33; 95% CI, 0.12-0.91).

“The findings from the present study suggest that choice of medication rather than glycemic control during the acute phase of ACS may have greater prognostic value. In particular, use of metformin after ACS episodes showed the lowest recurrence among antidiabetic medications,” the researchers wrote. “Although metformin was once contraindicated in patients with cardiac problems due to risk of lactic acidosis, our results support the current understanding of this medication, where the cardioprotective effects may outweigh the risks.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.