Effect Of Metformin Combined With Second-Line Hypoglycemic Drugs On The Prognosis Of Coronary Heart Disease Complicated With Type 2 Diabetes

Objectives A retrospective cohort study to investigate the advantage and disadvantage of metformin combined with second-line hypoglycemic drugs in the prognosis of coronary heart disease complicated with type 2 diabetes.Methods A retrospective research method was used to select hospital admissions in the Department of Cardiology and the Department of Cardiology of Affiliated Hospital of North China University of Technology from January 2018 to December 2020,and the main diagnosis was coronary heart disease,unstable Angina pectoris,acute myocardial infarction,old myocardial infarction,one of ischemic cardiomyopathy.At the same time,the secondary diagnosis includes type 2 diabetes;or the primary diagnosis is type 2diabetes,and the secondary diagnosis includes one of coronary heart disease,unstable angina,acute myocardial infarction,old myocardial infarction,and ischemic cardiomyopathy.A total of 3315 cases were found,and a total of 319 patients were found using oral metformin combined with second-line hypoglycemic drugs.According to different medication regimens,87 cases in metformin + acarbose group(MET + acarbose group),123 cases in metformin + sulfonylurea group(MET + sulfonylurea group),and metformin + glinide group(MET + sulfonylurea group)were included.Glinide group)109cases.Information was collected by filling out questionnaires,telephone follow-up,viewing electronic medical records in the inpatient system and appointment follow-up system for outpatient electronic medical records.Finally,“146 patients with complete basic data and regular medication for 12 months were followed up completely,including48 patients in the MET+acarbose group,49 patients in the MET+sulfonylurea group,and49 patients in the MET+glitinide group.Baseline data such as gender,age,body mass index,basal heart rate,smoking history,drinking history,cerebrovascular disease history,hypertension history and medication history were collected.Total cholesterol(TC)and triglyceride were collected at admission and after 12 months(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),lipoprotein a(Lp(a)),fasting blood glucose(GLU)and glycated hemoglobin(Hb A1C)levels.Cardiac ultrasound indicators,including left atrial diameter(LA),ventricular septal thickness(IVSD),left ventricular diastolic diameter(LVD),and ejection fraction(EF).Adverse outcome events(MACE)admissions within 12 months were recorded,including: non-fatal myocardial infarction,angina,heart failure,stroke,and death.Results 1 At admission,the three groups were significantly different in age,gender,body mass index,basal heart rate,smoking history,drinking history,hypertension history,smoking history,diabetes history,cerebrovascular disease history,blood lipids,fasting blood glucose level,Hb A1 C level,interventricular septum thickness,left There was no significant difference in ventricular end-diastolic diameter and ejection fraction,P>0.05.The left atrial diameter in the MET+acarbose group was smaller than that in the MET+glitinide group,and the difference was significant,P<0.05.2 The three groups were admitted to hospital There was no significant difference in total cholesterol,triglyceride,high-density lipoprotein,low-density lipoprotein,lipoprotein a,fasting blood glucose,left atrial diameter,interventricular septum thickness,and left ventricular enddiastolic diameter between the time and 12 months later.The difference,P>0.05.3 The difference of glycated hemoglobin at admission and 12 months after admission in the MET+acarbose group was higher than that in the MET+sulfonylurea group and MET+glitinide group,and the difference in left ventricular ejection fraction was higher than that in the MET+sulfonylurea group Class group and MET+glinide group,P<0.05.4The occurrence of MACE events in the three groups during the follow-up period showed that the MET+acarbose group had less non-fatal myocardial infarction and angina pectoris events than MET+sulfonylurea within 12 months Class group and MET+glinide class group,P<0.05.Multivariate analysis of 5MACE events showed that metformin+acarbose could be a protective factor for MACE events,and male was a protective factor for MACE events(OR=0.361,95%CI:0.155-0.834,P<0.05).Hypertension(OR=3.112,95%CI: 1.419-6.823,P<0.05)and smoking(OR=5.187,95%CI: 2.219-12.123,P<0.05)were risk factors for MACE events.Conclusions 1 Metformin combined with acarbose reduces glycated hemoglobin better than metformin combined with glinide and metformin combined with sulfonylureas.2Metformin combined with acarbose improves LVEF at 1 year compared with metformin combined with glinide and metformin combined with sulfonylureas.3 Metformin combined with acarbose reduces angina pectoris and non-fatal myocardial infarction in patients with coronary heart disease and type 2 diabetes mellitus than metformin combined with gline and metformin combined with sulfonylureas.Figure0;Table10;Reference 113...