Metformin after ACS limits repeat CVD episodes in type 2 diabetes

Komaru Y, et al. J Diabetes Complications. 2019;doi:10.1016/j.jdiacomp.2019.107511

Metformin may help adults with type 2 diabetes avoid additional cardiovascular disease events after an initial episode of acute coronary syndrome, or ACS, according to findings published in the Journal of Diabetes and its Complications.

“Patients with type 2 diabetes had higher incidence of recurrent CVD events compared with patients without diabetes. Glycemic control levels at admission did not affect the recurrence in patients with type 2 diabetes,” Tadashi Takeuchi, MD, of the Keio University Graduate School of Medicine in Tokyo, and colleagues wrote. “Among the type 2 diabetes group, patients receiving metformin during the acute phase of their ACS event showed a significantly lower incidence of recurrent CVD compared with those who did not receive metformin.”

Takeuchi and colleagues used medical records from St. Luke’s International Hospital in Tokyo for 569 adults who experienced ACS for the first time (mean age, 63.7 years; 17.2% women) to identify medication use and additional CVD events, such as cardiac death, myocardial infarction and ischemic stroke, during a mean 4.2 years of follow-up. 

Among the 198 patients with type 2 diabetes, 10.6% had cardiac death, 4% experienced an MI and 4.5% had an ischemic stroke (P = .008) vs. 1.6% with cardiac death (P < .001), 0.8% with MI and 1.1% with ischemic stroke (P = .008) among those without diabetes.

Metformin Adobe 2019 

Metformin may help adults with type 2 diabetes avoid additional cardiovascular disease events after an initial episode of acute coronary syndrome, or ACS.

The researchers noted that “there was no significant difference in the risk for recurrent CVD events by HbA1c levels.”

Among those prescribed diabetes drugs, 32.8% used metformin, 44.4% used thiazolidines and 30.8% used sulfonylureas, according to the researchers. Metformin use was associated with a 77% decrease in recurrent CVD risk vs. no metformin use (HR = 0.33; 955 CI, 0.12-0.91). 

“The findings from the present study suggest that choice of medication rather than glycemic controlduring the acute phase of ACS may have greater prognostic value. In particular, use of metformin after ACS episodes showed the lowest recurrence among antidiabetic medications,” the researchers wrote. “Although metformin was once contraindicated in patients with cardiac problems due to risk of lactic acidosis, our results support the current understanding of this medication, where the cardioprotective effects may outweigh the risks.” 

DisclosuresThe authors report no relevant financial disclosures.





Recurrent cardiovascular events in patients with newly diagnosed acute coronary syndrome: Influence of diabetes and its management with medication


Glycemic control on admission were not associated with recurrent cardiovascular events

Patients on metformin showed less recurrence of cardiovascular events

569 patients were followed after their first events of ACS




The effects of type 2 diabetes mellitus (T2DM) medications on secondary prevention after acute coronary syndrome (ACS) remain unclear. We evaluated recurrent cardiovascular disease (CVD) after primary diagnosis of ACS in T2DM patients.


This retrospective cohort study included 569 patients with newly diagnosed ACS from 2007 to 2012. The endpoint was recurrent CVD up to a five-year maximum follow-up until 2016. Kaplan–Meier analysis and Cox proportional hazard regressions were performed to examine the association between T2DM diagnosis, different antidiabetic drugs, and recurrent CVD.


Among 569 patients, 198 had T2DM. The mean follow-up was 1540 (interquartile range, 864–2157) days. Patients with diabetes showed higher risk of recurrent cardiovascular event compared with those without (P = 0.004). Patients with diabetes treated with metformin (65 patients) showed longer event-free survival, compared with those on other antidiabetic medications (P = 0.005). Multivariable analysis confirmed a reduced risk of recurrent CVD associated with metformin (hazard ratio, 0.33; 95% confidence interval, 0.12–0.91), while lower hemoglobin A1c levels on admission were not associated with better CVD outcomes.


T2DM increases risk of recurrent CVD after first ACS episode regardless of glycemic control on admission, while use of metformin may reduce recurrence.


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