In a recent article published in the Journal of Diabetes and Its Complications, researchers conducted a retrospective cohort study involving 569 patients with newly diagnosed acute coronary syndrome (ACS) from 2007 to 2012. The endpoint was recurrent cardiovascular disease (CVD) up to a 5-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. Takeuchi et al utilized 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 T2DM, 10.6% had cardiac death, 4% experienced an MI, and 4.5% had an ischemic stroke (P = .008) versus cardiac death in 1.6% (P <.001), MI in 0.8%, and ischemic stroke in 1.1% (P = .008) of those without diabetes.
Key findings from this study included the following:
• Among patients prescribed diabetes drugs, 32.8% used metformin, 44.4% used thiazolidines, and 30.8% used sulfonylureas.
• Metformin use was associated with a 77% decrease in recurrent CVD risk versus no metformin use (hazard ratio [HR] = 0.33; 95% CI, 0.12-0.91).
• More participants with T2DM had cardiac death, MI, or ischemic stroke compared to those without T2DM.
• Diabetic patients treated with metformin (n = 65) showed longer event-free survival compared with those receiving other antidiabetic medications (P = .005). Multivariable analysis confirmed a reduced risk of recurrent CVD associated with metformin (HR, 0.33; 95% CI, 0.12-0.91), while lower hemoglobin A1c levels on admission were not associated with better CVD outcomes.
The authors also noted that T2DM heightens the risk of recurrent cardiovascular events after the initial ACS episode, irrespective of glycemic control on admission, and that the use of metformin may lessen recurrence. The study concluded that among the T2DM group, patients receiving metformin during the acute phase of their ACS event demonstrated considerably less recurrent CVD compared with those who did not receive metformin.
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