Metformin × all-cause mortality

SynthesisDiabetes care2008

Is the combination of sulfonylureas and metformin associated with an increased risk of cardiovascular disease or all-cause mortality?: a meta-analysis of observational studies.

Ajay D Rao et al.PubMed ↗Full text ↗Publisher ↗

  • Combination therapy of sulfonylureas and metforminlooks bad hereNo clear link with deaths, no clear link with CVD deaths, more composite end point of CVD hospitalizations or deaths.Correlation only, not a test of it.

What moved togetherboth groups pooled, not the treatment’s effect

Correlation · may be no link

No clear link with deaths

+19%−12% to +62%

combination therapy of sulfonylureas and metformin vs diet therapy, metformin monotherapy, or sulfonylurea monotherapy

Bigger than 5 in 10 for all-cause mortality

As reported

RR 1.19, 95% CI 0.88–1.62 · the paper's word: all-cause mortality

Correlation · may be no link

No clear link with CVD deaths

1.3×0.7× to 2.3×

combination therapy of sulfonylureas and metformin vs diet therapy, metformin monotherapy, or sulfonylurea monotherapy

Bigger than 7 in 10 for all-cause mortality

As reported

RR 1.29, 95% CI 0.73–2.27 · the paper's word: CVD mortality

Correlation, not cause

Combination therapy of sulfonylureas and metformin went with more composite end point of CVD hospitalizations or deaths

+43%+10% to +85%

combination therapy of sulfonylureas and metformin vs diet therapy, metformin monotherapy, or sulfonylurea monotherapy

Bigger than 6 in 10 for adverse events & safety

As reported

RR 1.43, 95% CI 1.10–1.85 · the paper's word: composite end point of CVD hospitalizations or mortality (fatal or nonfatal events)

Who was studied, and how

people with cardiovascular disease, in this paper

Already taking combination therapy of sulfonylureas and metformin, or nottheir own situation, not assigned

on combination therapy of sulfonylureas and metformin
diet therapy, metformin monotherapy, or sulfonylurea monotherapy

No clear link with deaths+19%

No clear link with CVD deaths1.3×

Combination therapy of sulfonylureas and metformin went with more composite end point of CVD hospitalizations or deaths+43%

correlation, not a test

the abstract, start to end

of sulfonylureas and metformin were 1.19 (0.88-1.62) for all-cause mortality, 1.29 (0.73-2.27) for CVD mortality, and 1.43 (1.10-1.85) for a composite end

← favours treatmentfavours comparator →
could be chance
All-cause mortalitycombination therapy of sulfonylureas and metformin vs diet therapy, metformin monotherapy, or sulfonylurea monotherapy
RR 1.190.88–1.62
CVD mortalitycombination therapy of sulfonylureas and metformin vs diet therapy, metformin monotherapy, or sulfonylurea monotherapy
RR 1.290.73–2.27
Composite end point of CVD hospitalizations or mortality (fatal or nonfatal events)combination therapy of sulfonylureas and metformin vs diet therapy, metformin monotherapy, or sulfonylurea monotherapy
RR 1.431.10–1.85
MetforminSulfonylureas & glinidesAll-cause mortalityAdverse events & safety
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Full record →Abstract, authors, funding and every citing paper · PMID 18458139