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Review
. 2023 Oct 11;23(1):27-38.
doi: 10.1007/s40200-023-01309-y. eCollection 2024 Jun.

Effect of metformin (vs. placebo or sulfonylurea) on all-cause and cardiovascular mortality and incident cardiovascular events in patients with diabetes: an umbrella review of systematic reviews with meta-analysis

Mansour Bahardoust  1 , Sepideh Mousavi  2 , Mohsen Yariali  3 , Meisam Haghmoradi  4 , Farzad Hadaegh  5 , Davood Khalili  5 , Ali Delpisheh  1   6   7
Affiliations
Review

Effect of metformin (vs. placebo or sulfonylurea) on all-cause and cardiovascular mortality and incident cardiovascular events in patients with diabetes: an umbrella review of systematic reviews with meta-analysis

Mansour Bahardoust et al. J Diabetes Metab Disord. .

Abstract

Purpose: The current umbrella review aimed to evaluate the effect of metformin on all-cause mortality (ACM), cardiovascular mortality, and cardiovascular disease (CVD) incidence in DM patients.

Methods: PubMed, Scopus, Cochrane, Google Scholar, and Web of Science databases were searched with special keywords. Related studies were included after screening by two independent investigators based on title and full texts. The AMSTAR2 checklist was used to assess the quality of studies, and Cochran tests were used to assess the heterogeneity between studies. Overall, seventeen systematic reviews and meta-analysis studies were included. The results revealed that the risk of ACM in patients who received metformin was lower than in patients who did not receive metformin. (OR: 0.80, 95% CI:0.744,0.855); also, the risk of CVD mortality in metformin patients was lower than in the other two groups (placebo and other anti-diabetic drugs) (OR: 0.771, 95% CI:0.688,0.853, P:0.001). The risk of CVD in metformin users was also lower than in the other two groups (OR: 0.828, 95% CI:0.781,0.785).

Summary: This comprehensive review showed that the risk of ACM, death due to CVD, and incidents of CVD in DM who use metformin was lower than the patients who received a placebo only or other diabetic drugs, which can guide clinicians in medical decision-making.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-023-01309-y.

Keywords: Cardiovascular Disease; Diabetes Mellitus; Metformin; Mortality.

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Conflict of interest statement

Conflict of interestAll of the authors declare no competing interests or activities that could appear to have influenced the submitted work.

Figures

Fig. 1
Fig. 1
Flowchart screen of studies based on PRISMA 2020
Fig. 2
Fig. 2
Comparison of the effects of metformin on All-Cause Mortality based on the control group
Fig. 3
Fig. 3
Comparison of the effects of metformin on CVD Mortality based on the control group
Fig. 4
Fig. 4
Comparison of the effects of metformin on CVD events based on the control group
See this image and copyright information in PMC

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