Association of metformin with lower atrial fibrillation risk among patients with type 2 diabetes mellitus: a population-based dynamic cohort and in vitro studies
Open accessAbstract
BACKGROUND: Atrial fibrillation (AF), an inflammatory process involving arrhythmia, is associated with severe morbidity and mortality and commonly seen in patients with diabetes mellitus (DM). The effect of metformin, the most commonly used medication for patients with DM, on AF has not been investigated. The primary aim of this study was to examine whether metformin prevented the occurrence of AF in type 2 DM patients by analyzing a nationwide, population-based dynamic cohort. Additionally, we investigated the effect of metformin on tachycardia-induced myolysis and oxidative stress in atrial cells. METHODS: The study population included 645,710 patients with type 2 diabetes and not using other anti-diabetic medication from a subset of the Taiwan National Health Insurance Research Database. Of these patients, those who used metformin were categorized as the user group, and the remaining were classified as the non-user group. The time-dependent Cox's proportional hazard model was used to examine the effect of metformin on AF and the status of metformin use was treated as a time-dependent covariate. HL-1 atrial cells were paced with or without metformin, and then troponin and heavy-chain-myosin were measured as markers of myolysis. RESULTS: After 13 years of follow-up, 9,983 patients developed AF with an incidence rate of 1.5% (287 per 100,000 person-years). After adjusting for co-morbidities and medications, metformin independently protected the diabetic patients from new-onset AF with a hazard ratio of .81 (95% confidence interval 0.76-0.86, p < 0.0001). Metformin significantly decreased the extent of pacing-induced myolysis and the production of reactive oxygen species. CONCLUSION: Metformin use was associated with a decreased risk of AF in patients with type 2 DM who were not using other anti-diabetic medication, probably via attenuation of atrial cell tachycardia-induced myolysis and oxidative stress.
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Treatment with metformin seems to be associated with a decreased long-term risk of AF in diabetic patients.
“while treatment with metformin seems to be associated with a decreased long-term risk of AF in diabetic patients”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [286]
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- Authors
- Chang, S.-H., Wu, L.-S., Chiou, M.-J., Liu, J.-R., Yu, K.-H., Kuo, C.-F., Wen, M.-S., Chen, W.-J., Yeh, Y.-H., & See, L.-C.
- Affiliations
- Chang Gung University (TW)
- Chang Gung Memorial Hospital (TW)
- Corresponding author
- Yeh, Yung-Hsin
- See, Lai-Chu
- ORCID
- Venue
- Cardiovascular Diabetology
- Published
- 2014-08-10
- Volume
- 13
- Issue
- 1
- Pages
- 123-123
- ISSN
- 1475-2840 (ISSN-L)
- PMC
- PMC4149273
- OpenAlex
- W2150052417
- Cited by
- 225
- References
- 31
- Citations by year
- 2026: 11 · 2025: 13 · 2024: 24 · 2023: 22 · 2022: 32 · 2021: 27 · 2020: 27 · 2019: 21 · 2018: 13 · 2017: 14 · 2016: 12 · 2015: 9
- FWCI
- 8.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Cardiovascular Diabetology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Health Research Institutes
- National Health Insurance Administration
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
- Keywords
- metformin, atrial fibrillation, type 2 diabetes, oxidative stress, reactive oxygen species, atrial myocytes, HL-1 cells, antiarrhythmic effect, atrial arrhythmias
- MeSH terms
- Adult, Aged, Atrial Fibrillation, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Hypoglycemic Agents, Longitudinal Studies, Male, Metformin, Middle Aged, Population Surveillance, Risk Factors, Cohort Studies
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