Reduced Cardiovascular Morbidity and Mortality Associated With Metformin Use in Subjects With Type 2 Diabetes
Abstract
AIM: Metformin therapy reduces microvascular complications in Type 2 diabetes; questions remain, however, regarding its impact on macrovascular events. This study examined metformin use in relation to risk of cardiovascular-related hospitalization and mortality. METHODS: We conducted a retrospective cohort analysis, using Saskatchewan Health administrative databases to identify new users of oral antidiabetic drugs. Subject groups were defined by medication use during 1991-1999: sulphonylurea monotherapy, metformin monotherapy, or combination therapy. Deaths and non-fatal hospitalizations recorded during the study period were identified as cardiovascular-related from ICD-9 codes. The main outcome was a composite of first non-fatal hospitalization or death. Standard multivariate techniques, including propensity scores, were used to adjust for potential confounding. Multivariate Cox proportional hazard models were used to examine the relationship between metformin use and the composite endpoint. RESULTS: Metformin monotherapy was associated with a lower risk of the composite endpoint (adjusted hazard ratio 0.81; 95% confidence interval 0.68, 0.97) compared with sulphonylurea monotherapy. Combination therapy with meformin and a sulphonylurea was associated with lower mortality, but had similar hospitalization rates, to sulphonylurea monotherapy. CONCLUSIONS: Metformin monotherapy was associated with a lower risk of cardiovascular-related morbidity and mortality, and combination metformin and sulphonylurea therapy was associated with a reduced risk of fatal cardiovascular events, when compared with sulphonylurea monotherapy.
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Johnson et al. reported reduced cardiovascular morbidity and mortality benefits of metformin monotherapy versus sulfonylurea monotherapy.
“Similarly, Johnson et al. accessed the Saskatchewan Health Administrative databases for a retrospective study and also reported reduced cardiovascular morbidity and mortality benefits of metformin monotherapy versus sulfonylurea monotherapy (31).”
From A Critical Review of the Evidence That Metformin Is a Putative Anti-Aging Drug That Enhances Healthspan and Extends Lifespan (2021) · cites this paper as [31]
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- Authors
- Johnson, J. A., Simpson, S. H., Toth, E. L., & Majumdar, S. R.
- Affiliations
- University of Alberta (CA)
- Institute of Health Economics (CA)
- Corresponding author
- Johnson, J. A.
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2005-03-21
- Volume
- 22
- Issue
- 4
- Pages
- 497-502
- ISSN
- 0742-3071 (ISSN-L)
- 1464-5491
- OpenAlex
- W1994294400
- Cited by
- 161
- References
- 31
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 5 · 2023: 4 · 2022: 6 · 2021: 6 · 2020: 6 · 2019: 7 · 2018: 7 · 2017: 8 · 2016: 6 · 2015: 11 · 2014: 11 · 2013: 11 · 2012: 11
- FWCI
- 6.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- metformin, type 2 diabetes, cardiovascular morbidity, cardiovascular mortality, macrovascular complications, cardiovascular hospitalization, oral antidiabetic drugs
- MeSH terms
- Aged, Aged, 80 and over, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Drug Therapy, Combination, Epidemiologic Methods, Female, Hospitalization, Humans, Hypoglycemic Agents, Male, Metformin, Middle Aged, Saskatchewan, Sulfonylurea Compounds
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