Cardiovascular disease (CVD) is the leading cause of mortality in type 2 diabetes mellitus (T2DM) patients. The role of metformin in reducing cardiovascular events is well-established, but its effect on coronary artery inflammation in T2DM patients is still unclear. In this study, we evaluated 547 T2DM patients who underwent coronary computed tomography angiography (CCTA) at Wuhan Central Hospital. Using propensity score matching, we compared the attenuation of pericoronary adipose tissue (PCAT), an imaging marker of coronary artery inflammation, between patients treated with and without metformin. Multiple linear regression models were used to analyze the influence of metformin on PCAT attenuation. The results of the propensity-matched analysis showed that patients on metformin therapy had significantly lower PCAT attenuation, indicating reduced coronary inflammation. Specifically, the PCAT attenuation in the left anterior descending artery (LAD) and right coronary artery (RCA) was lower in the metformin group compared to the non-metformin group. Metformin use was independently associated with decreased LAD-PCAT attenuation in the multivariate regression analysis. The association of metformin with PCAT attenuation differed significantly in populations analyzed in subgroups of patients with obesity and chronic kidney disease. In conclusion, our study shows a preliminary signal that metformin therapy may be associated with decreased coronary artery inflammation in T2DM patients, as indicated by PCAT attenuation on CCTA. And this correlation may vary depending on the patient population. This initial finding suggests that PCAT attenuation could be potentially used as an imaging biomarker to monitor the anti-inflammatory effects of medication.

中文翻译：

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基于 2 型糖尿病患者冠状动脉周围脂肪组织衰减的二甲双胍治疗与冠状动脉炎症之间的关联

心血管疾病（CVD）是2型糖尿病（T2DM）患者死亡的主要原因。二甲双胍在减少心血管事件方面的作用已明确，但其对 T2DM 患者冠状动脉炎症的作用仍不清楚。在这项研究中，我们评估了 547 名在武汉市中心医院接受冠状动脉计算机断层扫描血管造影 (CCTA) 的 T2DM 患者。使用倾向评分匹配，我们比较了接受二甲双胍治疗和未接受二甲双胍治疗的患者之间冠状动脉炎症的成像标志物冠周脂肪组织（PCAT）的衰减。采用多元线性回归模型分析二甲双胍对PCAT衰减的影响。倾向匹配分析结果显示，接受二甲双胍治疗的患者 PCAT 衰减显着降低，表明冠状动脉炎症减轻。具体来说，与非二甲双胍组相比，二甲双胍组左前降支（LAD）和右冠状动脉（RCA）的 PCAT 衰减较低。在多变量回归分析中，二甲双胍的使用与 LAD-PCAT 衰减的降低独立相关。在肥胖和慢性肾病患者亚组中，二甲双胍与 PCAT 减弱的关联存在显着差异。总之，我们的研究显示了一个初步信号，即二甲双胍治疗可能与 T2DM 患者冠状动脉炎症的减少有关，如 CCTA 上的 PCAT 衰减所示。这种相关性可能会根据患者群体的不同而有所不同。这一初步发现表明 PCAT 减弱有可能用作成像生物标志物来监测药物的抗炎作用。