title: Metformin therapy and prognosis of patients with heart failure and new-onset diabetes mellitus. A propensity-matched study in the community.
abstract: OBJECTIVE
  To assess the effect of the commencement of metformin therapy (CMet) on the prognosis of patients with newly diagnosed heart failure (HF) and new-onset diabetes mellitus (DM) treated with a contemporary medical regimen.
  
  
  METHODS
  Prospective study of 1519 HF patients with DM during 9 years. Mean age was 71.7+/-7.8 years, 817 (53.8%) were women, and 780 (51.3%) had preserved systolic function. During a median follow-up of 56.9+/-18.2 months, 1045 patients (68.8%) died, 1344 (88.5%) were hospitalized for worsening HF, 593 (39.0%) did not CMet, and 391 of the patients CMet (42.2%) had a mean HbA1c=<7.0%. No case of lactic acidosis due to metformin was observed. We propensity-score matched 592 patients who CMet with another 592 patients non-CMet.
  
  
  RESULTS
  CMet was associated with a decreased mortality (HR [CI 95%]: .85 [.82-.88]), mainly due to a reduced cardiovascular mortality (HR: .78 [.74-.82]), and with a lower hospitalization rate (HR: .81 [.79-.84]). Nevertheless, CMet was not associated with an improved prognosis of HF patients with a mean HbA1c=<7.0%. These relationships of CMet with prognosis were maintained, independently of the gender, the type of HF (systolic or, non-systolic), the comorbidities, and the medication used (P<.01).
  
  
  CONCLUSIONS
  Metformin therapy is associated with a reduced mortality of heart failure patients with new-onset diabetes mellitus, mainly due to a decreased cardiovascular mortality, and with a lower hospitalization rate. Nevertheless, CMet was not associated with an improved prognosis of HF patients with a mean HbA1c=<7.0%.
authors: Department of Medicine, Hospital Universitario Puerto Real, Cadiz, Spain.
authors: Sotero P
authors: SP
authors: Romero
authors: Jose L
authors: JL
authors: Andrey
authors: Antonio
authors: A
authors: Garcia-Egido
authors: Miguel A
authors: MA
authors: Escobar
authors: Virginia
authors: V
authors: Perez
authors: Ramón
authors: R
authors: Corzo
authors: Gloria J
authors: GJ
authors: Garcia-Domiguez
authors: Francisco
authors: F
authors: Gomez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011379:Prognosis; D057216:Propensity Score; D011446:Prospective Studies; D012111:Residence Characteristics; D016896:Treatment Outcome
chemical_list: D008687:Metformin