Metformin and Risk of New-Onset Atrial Fibrillation in Type 2 Diabetes: A Systematic Review and Meta-Analysis

Area of Science:

• Cardiology
• Endocrinology
• Pharmacology

Background:

• Atrial fibrillation (AF) is a prevalent cardiac arrhythmia globally.
• Type 2 diabetes mellitus (T2DM) significantly increases AF risk, contributing to morbidity and mortality.
• Metformin's impact on AF in T2DM patients requires further investigation.

Purpose of the Study:

• To evaluate the association between metformin and the risk of incident AF in T2DM patients.
• To compare metformin's effect on AF risk against other hypoglycemic agents.

Main Methods:

• A meta-analysis of seven studies involving over 4 million T2DM patients.
• Hazard ratios (HR) and 95% confidence intervals (CI) were pooled using a random effects model.
• Meta-regression analysis was employed to identify influencing factors, including age.

Main Results:

• Metformin was associated with a significantly lower risk of new-onset AF compared to other hypoglycemic agents (aHR: 0.85; 95% CI 0.76-0.94; p = 0.002).
• Age was identified as a significant moderator, with older patients showing a weaker association between metformin and AF risk.
• The study included a large cohort with a mean age of 62.82 years and 52.5% male participants.

Conclusions:

• Metformin use is associated with a reduced risk of new-onset AF in patients with T2DM.
• The protective association of metformin against AF is attenuated in older T2DM patients.
• These findings highlight metformin's potential cardiovascular benefits beyond glycemic control.