Evidence map›Paper›PMID 31815634›Full record

Observational studyCardiovascular diabetology2019

Metformin use and cardiovascular outcomes after acute myocardial infarction in patients with type 2 diabetes: a cohort study.

Daniel I Bromage, Tom R Godec, Mar Pujades-Rodriguez, Arturo Gonzalez-Izquierdo, S Denaxas, Harry Hemingway, Derek M Yellon

Open access · goldFull text readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Cardiovascular diabetology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 4 pooled it
3.8field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 4 syntheses or guidelines pooled it, 44 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 5 institutions in 1 country.

Daniel I BromageThe Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK.ORCID 0000-0002-4243-5964
Tom R GodecThe London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK.
Mar Pujades-RodriguezLeeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9JL, UK.
Arturo Gonzalez-IzquierdoInstitute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK.
S DenaxasInstitute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK.
Harry HemingwayInstitute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK.
Derek M YellonThe Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK. d.yellon@ucl.ac.uk.
University of London · GBKing's College London · GBLondon School of Hygiene & Tropical Medicine · GBUniversity College London · GBUniversity of Leeds · GB

Funding

Arthritis Research UKBritish Heart FoundationCancer Research UKChief Scientist OfficeDepartment of Health 05/40/04Department of Health RP-PG-0407-10314Department of Health SGL020\1087Medical Research Council MR/K006584/1Medical Research Council MR/L002043/1Wellcome TrustWellcome Trust 086091/Z/08/Z
6 · The paper itself

Abstract

backgroundThe use of metformin after acute myocardial infarction (AMI) has been associated with reduced mortality in people with type 2 diabetes mellitus (T2DM). However, it is not known if it is acutely cardioprotective in patients taking metformin at the time of AMI. We compared patient outcomes according to metformin status at the time of admission for fatal and non-fatal AMI in a large cohort of patients in England.

methodsThis study used linked data from primary care, hospital admissions and death registry from 4.7 million inhabitants in England, as part of the CALIBER resource. The primary endpoint was a composite of acute myocardial infarction requiring hospitalisation, stroke and cardiovascular death. The secondary endpoints were heart failure (HF) hospitalisation and all-cause mortality.

results4,030 patients with T2DM and incident AMI recorded between January 1998 and October 2010 were included. At AMI admission, 63.9% of patients were receiving metformin and 36.1% another oral hypoglycaemic drug. Median follow-up was 343 (IQR: 1-1436) days. Adjusted analyses showed an increased hazard of the composite endpoint in metformin users compared to non-users (HR 1.09 [1.01-1.19]), but not of the secondary endpoints. The higher risk of the composite endpoint in metformin users was only observed in people taking metformin at AMI admission, whereas metformin use post-AMI was associated with a reduction in risk of all-cause mortality (0.76 [0.62-0.93], P = 0.009).

conclusionsOur study suggests that metformin use at the time of first AMI is associated with increased risk of cardiovascular disease and death in patients with T2DM, while its use post-AMI might be beneficial. Further investigation in well-designed randomised controlled trials is indicated, especially in view of emerging evidence of cardioprotection from sodium-glucose co-transporter-2 (SGLT2) inhibitors.

Indexed as

AgedAged, 80 and overCause of DeathDatabases, FactualDiabetes Mellitus, Type 2Disease ProgressionEnglandFemaleHumansHypoglycemic AgentsIncidenceLongitudinal StudiesMaleMetforminMiddle AgedMyocardial InfarctionHypoglycemic AgentsMetforminAcute myocardial infarctionCardioprotectionCohort studiesMetforminOutcomesType 2 diabetes

Identifiers

PMID31815634
PMCPMC6900858
OpenAlexW2995727576

What OpenQuestion holds

Textfull text, public
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.