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Multicenter Study
. 2024 Nov 8;14(1):27280.
doi: 10.1038/s41598-024-77280-2.

Metformin associates with higher myocardial perfusion reserve and survival in type 2 diabetes mellitus patients

Noor Sharrack  1 , Kristopher D Knott  2   3 , Gaurav S Gulsin  4 , Tushar Kotecha  3   5 , Louise A E Brown  6 , Jian L Yeo  4 , Aldostefano Porcari  5   7 , Robert D Adam  2   3   8 , Sharmaine Thirunavukarasu  6 , Amrit Chowdhary  6 , Eylem Levelt  6 , James C Moon  2   3 , Gerry P McCann  4 , Marianna Fontana  3   5 , Peter Kellman  9 , Theresa Munyombwe  10   11 , Chris P Gale  10   11   12 , David L Buckley  6 , John P Greenwood  6 , Peter P Swoboda  6 , Sven Plein  13
Affiliations
Multicenter Study

Metformin associates with higher myocardial perfusion reserve and survival in type 2 diabetes mellitus patients

Noor Sharrack et al. Sci Rep. .

Abstract

Metformin is an antihyperglycemic used to treat type 2 diabetes mellitus (T2DM). Patients with T2DM are at increased risk of cardiovascular disease. We explored the association between metformin use and cardiovascular magnetic resonance (CMR) derived stress myocardial blood flow (MBF), myocardial perfusion reserve (MPR) and major adverse cardiovascular events (MACE; all cause death, MI, stroke, heart failure hospitalisation and coronary revascularisation) in patients with T2DM. Multi-centre study of patients with T2DM, and healthy controls, underwent quantitative myocardial perfusion CMR using an artificial intelligence supported process. Multivariable regression analysis, and cox proportional hazard models of propensity score weighted patients quantified associations between metformin use, MBF, MPR, all cause death and MACE. Analysis included 572 patients with T2DM (68% prescribed metformin) with median follow-up 851 days (IQR 935 - 765). Metformin use was associated with an increase of MPR of 0.12 [0.08-0.40], p = 0.004. There were 82 MACE events (14.3%) including 25 (4.4%) deaths of which 16 were in those not prescribed metformin (8.7%), compared to 9 in patients prescribed metformin (2.3%): adjusted hazard ratio 0.24 (95% CI 0.08-0.70, p = 0.009). MACE events were similar between groups. This multicentre, inverse probability weighting propensity score analysis study showed that in patients with T2DM, metformin use is associated with higher MPR and improved all cause survival.

Keywords: Endothelial dysfunction; Major adverse cardiovascular events (MACE); Metformin; Myocardial perfusion reserve (MPR); Stress myocardial blood flow (MBF); Type 2 diabetes mellitus (T2DM).

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival curves and at risk table for all cause mortality per metformin status. P value < 0.001*. P value is considered significant at < 0.05.
Fig. 2
Fig. 2
This retrospective, multicentre, longitudinal cohort study showed that in patients with T2DM, metformin use is associated with higher MPR on quantitative perfusion cardiovascular magnetic resonance imaging and improved all cause survival.
See this image and copyright information in PMC

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