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Observational Study
. 2020 Nov-Dec;17(6):1479164120973676.
doi: 10.1177/1479164120973676.

Diabetes, metformin and glucose lowering therapies after myocardial infarction: Insights from the SWEDEHEART registry

Viveca Ritsinger  1   2 , Bo Lagerqvist  3 , Pia Lundman  4 , Emil Hagström  3 , Anna Norhammar  1   5
Affiliations
Observational Study

Diabetes, metformin and glucose lowering therapies after myocardial infarction: Insights from the SWEDEHEART registry

Viveca Ritsinger et al. Diab Vasc Dis Res. 2020 Nov-Dec.

Abstract

Objective: To explore real-life use of glucose lowering drugs and prognosis after acute myocardial infarction (AMI) with a special focus on metformin.

Methods: Patients (n = 70270) admitted for AMI 2012-2017 were stratified by diabetes status and glucose lowering treatment and followed for mortality and MACE+ (AMI, heart failure (HF), stroke, mortality) until end of 2017 (mean follow-up time 3.4 ± 1.4 years) through linkage with national registries and SWEDEHEART. Hazard ratios (HR) were calculated in adjusted Cox proportional hazard regression models.

Results: Mean age was 68 ± 11 years and 70% were male. Of patients with diabetes (n = 16356; 23%), a majority had at least one glucose lowering drug (81%) of whom 51% had metformin (24% monotherapy), 43% insulin and a minority any SGLT2i/GLP-1 RA (5%). Adjusted HR for patients with versus without diabetes was 1.31 (95% CI 1.27-1.36) for MACE+ and 1.48 (1.41-1.56) for mortality. Adjusted HR for MACE+ for diabetes patients on metformin was 0.92 (0.85-0.997), p = 0.042 compared to diet treated diabetes.

Conclusion: Diabetes still implies a high complication risk after AMI. Metformin and insulin were the most common treatment used in almost half of the diabetes population. Furthermore, patients treated with metformin had a lower cardiovascular risk after AMI and needs to be confirmed in prospective controlled trials.

Keywords: Diabetes; glucose lowering treatment; metformin; myocardial infarction; outcome.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: V.R. has received honoraria on expert group participation from Astra Zeneca, Novo Nordisk and Boehringer Ingelheim. A.N. has received honoraria from Astra Zeneca, Merck Sharp & Dohme, Eli Lilly and Company, Novo Nordisk and Boehringer Ingelheim on expert group participation. B.L. reports no conflicts of interest. E.H. reports participation in expert committees, lecturing fees from Bayer, AstraZeneca and NovoNordisk and institutional grants from Sanofi and Amgen. P.L. has received honoraria for expert group participation and speaker’s fees from Astra Zeneca, Amgen, Boehringer-Ingelheim, Novo-Nordisk and Sanofi.

Figures

Figure 1.
Figure 1.
Time to hospitalisation for (a) MACE+ (first of myocardial infarction, heart failure, stroke or death), (b) MACE (first of myocardial infarction, stroke or death) and (c) mortality after index myocardial infarction by diabetes status. Mortality the first 90 days were excluded. Adjusted Hazard Ratios with 95% CI are presented in the figure.
Figure 2.
Figure 2.
Time to hospitalisation for MACE+ (first of myocardial infarction, heart failure, stroke or death) after index myocardial infarction by: (a) diabetes status and glucose lowering treatment and for clarity and (b) by diabetes status and treatment with metformin. Mortality the first 90 days were excluded.
Figure 3.
Figure 3.
Adjusted associated HR (95% CI) for MACE + (mortality, myocardial infarction, stroke or heart failure) by diabetes status and treatment groups. Diet treated diabetes patients were used as reference with HR 1.0.
Figure 4.
Figure 4.
Glucose lowering treatment over time 2012–2017 in patients discharged after myocardial infarction. Relative proportion of patients per group by year. Individual patients could only belong to one group.
See this image and copyright information in PMC

References

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