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

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.

Geroscience‐guided repurposing of FDA‐approved drugs to target aging: A proposed process and prioritization

“…UK Prospective Diabetes Study (UKPDS) Group,” 1998). Ample observational evidence supports survival benefits in people with diabetes treated with metformin, including when compared to people without diabetes (Bannister et al, 2014; Campbell et al, 2017; Jong et al, 2019; Ritsinger et al, 2020).…”

“…SGLT2i demonstrated the most robust clinical evidence for reduction of death from any cause and CVD, in patients with or without T2D, heart failure, and chronic kidney disease (CKD) (Cavender et al, 2018;Heerspink et al, 2020;Neal et al, 2017;Packer et al, 2020;Perkovic et al, 2019) Group," 1998). Ample observational evidence supports survival benefits in people with diabetes treated with metformin, including when compared to people without diabetes (Bannister et al, 2014;Campbell et al, 2017;Jong et al, 2019;Ritsinger et al, 2020).…”

Long-term prognosis in patients with acute myocardial infarction and newly detected glucose abnormalities: predictive value of oral glucose tolerance test and HbA1c

“…By screening for glucose disturbances in patients with AMI, lifestyle modification and pharmacological treatment can be initiated earlier. In a recently published register study, it was shown that patients with prediabetes treated with metformin have an improved outcome [ 21 ]. However, whether early lifestyle and medical interventions have a positive effect on short- and/or long-term outcome needs to be further established in randomised intervention studies.…”

Drug repositioning candidates identified using in-silico quasi-quantum molecular simulation demonstrate reduced COVID-19 mortality in 1.5M patient records

“…For example, Metformin (a) inhibits gluconeogenesis thus reducing blood sugar 27 and (b) helps activate pro-survival kinase AMPK which via mitochondria involved metabolic pathways results in cardiovascular health and lifespan improvement. 28 Triamcinolone, a synthetic glucocorticoid, is used to treat autoimmune diseases, asthma, rheumatoid and arthritic conditions. 29 , 30 , 31 The beta-lactam antibiotic, Amoxicillin, inhibits transpeptidation required for bacterial cell membrane synthesis.…”