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Metformin was associated with a reduction in all-cause mortality, but not a composite study endpoint, in high-risk patients with type 2 diabetes mellitus, a <a href="https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.040144">post-hoc analysis</a> suggests.The Saxagliptin and Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus (SAVOR-TIMI 53) study, whose results were previously published in 2013, included 12,156 patients with type 2 diabetes who were classified as eitehr taking or never taking metformin. The researchers for SAVOR-TIMI 53 used inverse probability of treatment weighting Cox modeling to obtain a composite endpoint of cardiovascular death, myocardial infarction (MI), or ischemic stroke. Additional endpoints included all-cause mortality and cardiovascular death, as well as biomarkers included as covariates.There was a total of 937 composite outcomes events, 407 cardiovascular deaths, and 600 all-cause deaths during the study period, with a median follow-up of 2.1 years. According to the analysis, of the 12,156 patients with baseline biomarker samples, most (74%; n=8,971) had metformin exposure, 13% (n=1,611) had prior heart failure, and 11% (n=1,332) had moderate chronic kidney disease. There was no reported difference for the composite study endpoint with metformin use (HR for inverse probability of treatment weighting=0.92; 95% CI, 0.76-1.11). However, there was a reduction in all-cause mortality (HR for inverse probability of treatment weighting=0.75; 95% CI, 0.59 to 0.95). The analysis authors reported no relationship between metformin use and the study endpoints in the patients with prior heart failure and severe chronic kidney disease.&ldquo;Taken together, the findings presented here show a strong association between metformin exposure and lower rates of all-cause mortality in patients with type 2 diabetes mellitus and elevated cardiovascular risk,&rdquo; the researchers wrote.They concluded by emphasizing that they took extra steps to reduce confounding in the data.&ldquo;Using extensive statistical techniques to adjust and match for comorbidities, patient characteristics, baseline biomarkers, and propensity for metformin exposure, we found that in patients with <a href="https://www.docwirenews.com/home-page-editor-picks/ptsd-type2diabetes/">type 2 diabetes</a> mellitus and high cardiovascular risk, metformin use was associated with lower rates of all-cause mortality but not with lower rates of the composite end point of cardiovascular death, MI, or ischemic stroke,&rdquo; they concluded. &ldquo;This association was most apparent in those patients without prior heart failure or moderate to severe <a href="https://www.docwirenews.com/docwire-pick/cardiology-picks/patiromer-spironolactone-ckd-heart-failure/">chronic kidney disease</a>. These findings emphasize the need for an adequately powered randomized trial in these high-risk patients.&rdquo;<blockquote class="twitter-tweet" data-width="500" data-dnt="true">
Promising data for <a href="https://twitter.com/hashtag/metformin?src=hash&amp;ref_src=twsrc%5Etfw">#metformin</a>: &#11015;&#65039; all-cause mortality for people with <a href="https://twitter.com/hashtag/diabetes?src=hash&amp;ref_src=twsrc%5Etfw">#diabetes</a> and &#11014;&#65039; <a href="https://twitter.com/hashtag/cardiovascular?src=hash&amp;ref_src=twsrc%5Etfw">#cardiovascular</a> risk 
(caveat: effect less in HF &amp; mod-severe CKD). <a href="https://twitter.com/hashtag/CardioTwitter?src=hash&amp;ref_src=twsrc%5Etfw">#CardioTwitter</a> <a href="https://twitter.com/hashtag/endotwitter?src=hash&amp;ref_src=twsrc%5Etfw">#endotwitter</a> <a href="https://t.co/Zrq4J7W3uG">https://t.co/Zrq4J7W3uG</a>
&mdash; Rachel Pessah-Pollack, M.D., F.A.C.E. (@DrPess) <a href="https://twitter.com/DrPess/status/1174495588559327233?ref_src=twsrc%5Etfw">September 19, 2019</a>
</blockquote><script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>http://twitter.com/ten0v/statuses/1174401148268294144<blockquote class="twitter-tweet" data-width="500" data-dnt="true">
<a href="https://twitter.com/hashtag/metformin?src=hash&amp;ref_src=twsrc%5Etfw">#metformin</a> use was associated with lower rates of all-cause mortality, including after adjustment for clinical variables and biomarkers, but not lower rates of the composite end point of cardiovascular death, myocardial infarction, or ischemic stroke. <a href="https://t.co/PLzLE7vqJL">https://t.co/PLzLE7vqJL</a>
&mdash; &#120019;&#120059;. &#120031;&#120042;&#120043;&#120053;&#120056; &#120028;&#120056;&#120059;&#120056;&#120044;&#120049;&#120056; &#120033;&#120050;&#120056;&#120047;&#120059;&#120050;&#120056; (@PabloMorochoRMD) <a href="https://twitter.com/PabloMorochoRMD/status/1173969489341440003?ref_src=twsrc%5Etfw">September 17, 2019</a>
</blockquote><script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script><blockquote class="twitter-tweet" data-width="500" data-dnt="true">
In post hoc analysis of SAVOR-TIMI 53, metformin associated w/ (down arrow) all-cause mortality, but not MACE. However, effect not seen in pts w/ HF or mod-sev CKD. <a href="https://t.co/Zz8Tva9oqM">https://t.co/Zz8Tva9oqM</a> <a href="https://twitter.com/hashtag/AHAJournals?src=hash&amp;ref_src=twsrc%5Etfw">#AHAJournals</a> <a href="https://twitter.com/BrianBergmark?ref_src=twsrc%5Etfw">@BrianBergmark</a> <a href="https://twitter.com/TIMIStudyGroup?ref_src=twsrc%5Etfw">@TIMIStudyGroup</a> <a href="https://twitter.com/BrighamWomens?ref_src=twsrc%5Etfw">@BrighamWomens</a> <a href="https://twitter.com/BrighamResearch?ref_src=twsrc%5Etfw">@BrighamResearch</a> @DLBhattD <a href="https://t.co/Iawd4zLQms">pic.twitter.com/Iawd4zLQms</a>
&mdash; Circulation (@CircAHA) <a href="https://twitter.com/CircAHA/status/1174397775028588550?ref_src=twsrc%5Etfw">September 18, 2019</a>
</blockquote><script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>&nbsp;

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Analysis: Metformin Lowers All-cause Death in Type 2 Diabetics

Cardiology

Metformin was associated with a reduction in all-cause mortality, but not a composite study endpoint, in high-risk patients with type 2 diabetes mellitus, a post-hoc analysis ...

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