Sanjoy K Paul1, Kerenaftali Klein1,2, Azeem Majeed3, Kamlesh Khunti4. 1. Clinical Trials and Biostatistics Unit, QIMR Berghofer Medical Research Institute, Brinsbane, Queensland, Australia. 2. Statistics Unit, QIMR Berghofer Medical Research Institute, Brinsbane, Queensland, Australia. 3. Department of Primary Care and Public Health, Imperial College London, London, UK. 4. Diabetes Research Centre, University of Leicester, Leicester, UK.
Abstract
BACKGROUND: The cardiovascular and mortality risk in patients with incident type 2 diabetes (T2D) in relation to smoking status and concurrent use of metformin is not well known. METHODS: A cohort study was performed in 82,205 incident T2D patients from the U.K. Clinical Practice Research Datalink. In the present study, the risks of myocardial infarction (MI), stroke, and mortality in incident T2D patients were evaluated in relation to their smoking status with and without concurrent use of metformin. RESULTS: Over a median 5.4 years of follow-up, of patients without a history of cardiovascular disease (CVD) before a diagnosis of diabetes (n = 63,166), current smokers with and without metformin had an 8% (hazard ratio [HR] 1.08; 95% confidence interval [CI] 0.81, 1.45) and 32% (HR 1.32; 95% CI 1.07, 1.65) increased risk of MI or stroke, respectively, compared with non-smokers without metformin treatment. The respective HRs (95% CI) for mortality in these patients were 0.96 (0.83, 1.11) and 1.86 (1.68, 2.07). The HR for mortality among ex-smokers with and without concurrent metformin treatment was 0.92 (95% CI 0.83, 1.11) and 1.19 (95% CI 1.10, 1.30), respectively. Similar beneficial modifiable effects of metformin among ex- and current smokers were observed in patients with CVD before diagnosis of diabetes (n = 19,039). CONCLUSIONS: In T2D patients, concurrent treatment with metformin attenuates the observed higher cardiovascular and mortality risk in ex- and current smokers. In addition to smoking cessation support, treatment with metformin, particularly in ex- and current smokers, should be encouraged.
BACKGROUND: The cardiovascular and mortality risk in patients with incident type 2 diabetes (T2D) in relation to smoking status and concurrent use of metformin is not well known. METHODS: A cohort study was performed in 82,205 incident T2D patients from the U.K. Clinical Practice Research Datalink. In the present study, the risks of myocardial infarction (MI), stroke, and mortality in incident T2D patients were evaluated in relation to their smoking status with and without concurrent use of metformin. RESULTS: Over a median 5.4 years of follow-up, of patients without a history of cardiovascular disease (CVD) before a diagnosis of diabetes (n = 63,166), current smokers with and without metformin had an 8% (hazard ratio [HR] 1.08; 95% confidence interval [CI] 0.81, 1.45) and 32% (HR 1.32; 95% CI 1.07, 1.65) increased risk of MI or stroke, respectively, compared with non-smokers without metformin treatment. The respective HRs (95% CI) for mortality in these patients were 0.96 (0.83, 1.11) and 1.86 (1.68, 2.07). The HR for mortality among ex-smokers with and without concurrent metformin treatment was 0.92 (95% CI 0.83, 1.11) and 1.19 (95% CI 1.10, 1.30), respectively. Similar beneficial modifiable effects of metformin among ex- and current smokers were observed in patients with CVD before diagnosis of diabetes (n = 19,039). CONCLUSIONS: In T2D patients, concurrent treatment with metformin attenuates the observed higher cardiovascular and mortality risk in ex- and current smokers. In addition to smoking cessation support, treatment with metformin, particularly in ex- and current smokers, should be encouraged.
Authors: Peter L Elkin; Sarah Mullin; Sheldon Tetewsky; Skyler D Resendez; Wilmon McCray; Joseph Barbi; Sai Yendamuri Journal: J Thorac Cardiovasc Surg Date: 2022-03-10 Impact factor: 6.439
Authors: Alexey V Zilov; Sulaf Ibrahim Abdelaziz; Afaf AlShammary; Ali Al Zahrani; Ashraf Amir; Samir Helmy Assaad Khalil; Kerstin Brand; Nabil Elkafrawy; Ahmed A K Hassoun; Adel Jahed; Nadim Jarrah; Sanaa Mrabeti; Imran Paruk Journal: Diabetes Metab Res Rev Date: 2019-07-24 Impact factor: 4.876
Authors: M A Salinero-Fort; F J San Andrés-Rebollo; J Cárdenas-Valladolid; M Méndez-Bailón; R M Chico-Moraleja; E Carrillo de Santa Pau; I Jiménez-Trujillo; I Gómez-Campelo; C de Burgos Lunar; J M de Miguel-Yanes Journal: Sci Rep Date: 2021-07-27 Impact factor: 4.379