*For medical professionals only
“img class=”responsive ” sizes=”(min-width: 320px) 320px, 100vw” src=”https://mmbiz.qpic.cn/mmbiz_png/x5F5KAyDKw19I4VvcibrfNia7lD1fial5KribXqZxjxMxtoc3ichKKz6ib3w5kJias8QNRBYGn80MM0AxEgOvRLibqE2uw/640″ width=”6400″ >2typediabetesincreased risk of disease and cardiovascular disease2 to 3 times related. While mechanisms related to blood glucose may be a factor, clinical trials of intensive blood glucose management to reduce risk have had mixed results, with one positive trial suggesting that intensive blood glucose management has long-term effects in myocardial infarction survivors. beneficial effects.
The link between diabetes and pathogenesis may be related to early metabolic disorders, such as insulin resistance and prediabetes. This concept suggests that interventions in early prediabetes may have greater benefits in reducing cardiovascular disease (CVD).
The DPP trial (Diabetes Prevention Program) showed a 58% reduction in cumulative diabetes incidence and a 31% reduction in metformin compared to placebo. In continued follow-up of the DPPOS (DPP Endpoint Study), the benefit of preventing diabetes persisted for up to 15 years after randomization.
In view of the suggestive benefit of metformin in the UKPDS study (UK Prospective Diabetes Study) and its beneficial effects on cardiovascular risk factors, arterial wall and coronary artery calcification, DPPOS recently focused on the cardiovascular effects of metformin.
Recently, the journal Circulation published a study evaluating the effects of initial DPP randomization to metformin or lifestyle intervention, compared with placebo, on major adverse cardiovascular events. influences. Let’s take a look together!
Study Design
During DPP, 3234 Participants with impaired glucose tolerance were randomly assigned to:
metformin (850 mg, Bid), intensive lifestyle intervention, or placebo,
Follow-up for 3 years.
At a mean follow-up of 18 years after DPPOS,
all participants received
Metformin group continued to use unmasked metformin after a less intensive group lifestyle intervention.
Primary endpoint: first occurrence of non-fatal myocardial infarction, stroke, or cardiovascular death (adjudicated by criteria).
Expanded cardiovascular endpoints: including the primary endpoint, either due to heart failure, or unstable angina, coronary or peripheral revascularization, angiographically diagnosed coronary artery disease, or Hospitalization due to asymptomatic myocardial infarction diagnosed by electrocardiogram.
The electrocardiogram and cardiovascular risk factors are tested annually.
Findings
Neither metformin nor lifestyle interventions reduced the primary endpoint: span>
The hazard ratio in the metformin group versus placebo was 1.03 (95% CI, 0.78-1.37; P = 0.81),
The hazard ratio in the lifestyle intervention group versus placebo was 1.14 (95% CI, 0.87-1.50; P = 0.34).
Cumulative incidence of major adverse cardiovascular events (MACE) and individual cardiovascular event components, by intervention group span>
A The effect of the intervention on the cumulative incidence of the first MACE (%); The MACEs are:
B non-fatal myocardial infarction; C non-fatal stroke; D cardiovascular death
Adjusting for risk factors did not change these results.
Neither intervention had an effect on the expanded cardiovascular endpoint.
Conclusions
Metformin and lifestyle did not reduce DPPOS despite long-term diabetes prevention Major cardiovascular events over 21 years.
Providing group lifestyle interventions to all, extensive off-study statin and antihypertensive use, and reduced on-study metformin use, and off-study metformin use, May dilute the effect of interventions.
Research innovations
In a 21-year follow-up of 3234 DPP participants who started with impaired glucose tolerance and were followed in DPPOS. andNeither metformin nor the lifestyle intervention reduced major adverse cardiovascular events compared with placebo, although there was a reduction in the incidence of diabetes.
Should start with moderate progression of hyperglycemia, extensive use of lipid-lowering and antihypertensive medications outside of the study, lower-intensity These findings were viewed in terms of lifestyle interventions and increases in off-study metformin use over time. This may both limit the apparent effect of the intervention and be a valuable prevention strategy.
Clinical significance
Although metformin and lifestyle interventions can significantly reduce diabetes progression in the long term, there is a small amount of cardiovascular disease associated with impaired glucose tolerance or early type 2 diabetes, and In the context of modern hypoglycemic, lipid-lowering, and antihypertensive treatment strategies, metformin and lifestyle interventions may not have additional effects on cardiovascular disease prevention.
Metformin and lifestyle interventions reduce the risk of type 2 diabetes, but may not when blood sugar, lipids, and blood pressure are well controlled Provides additional protection against cardiovascular disease.
Source:
Effects of Long-term Metformin and Lifestyle Interventions on Cardiovascular Events in the Diabetes Prevention Program and Its Outcome Study. Circulation. 2022 May 31;145(22):1632-1641. doi: 10.1161/CIRCULATIONAHA.121.056756.
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