Metforminetherapie verlaagt mortaliteit bij diabetespatiënten met HF

Researchers report that treatment with metformin appears to reduce mortality rates in patients with heart failure (HF) and diabetes.

David Aguilar (Baylor College of Medicine, Houston, Texas, USA) and colleagues explain that although diabetes and HF commonly co-exist, optimal treatment for such patients has not been studied in detail.

To investigate the possible benefits of metformin for these patients, Aguilar and team studied mortality rates over 2 years of follow-up in 6185 patients with HF and diabetes, of whom 1561 were treated with metformin and 4624 were not.All the patients were taking a combination of other drugs including: insulin, sulfonylureas, thiazolidinediones, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, spironolactone, beta blockers, and statins.

As reported in the journal Circulation: Heart Failure, 246 (15.8%) patients taking metformin and 1177 (25.5%) of those who were not taking the medication died during follow-up, a statistically significant between-group difference.

The researchers carried out a propensity-score (probability of being treated given the covariates) matched analysis. This showed that death occurred within 2 years in 232 (16.1%) and 285 (19.8%) patients in the metformin and no metformin groups, respectively, corresponding to a significant 24% reduction in the relative risk for death with metformin.

Of note, the investigators found no significant differences in hospitalization for HF or total hospitalization rates between the two groups.

"Given the current burden and expected growth in the number of patients with diabetes and HF, it is critically important that future studies assess the optimal treatment strategy for glycemic control in this population," say Aguilar and co-authors.

"Addressing these issues will require carefully designed prospective observational studies to confirm safety and randomized controlled clinical trials to assess efficacy," they conclude.