Does Metformin therapy impact CVD in T2D? It’s complicated

Metformin’s value as a glucose-lowering agent has been established for decades, but does it hold similar promise for reducing rates of cardiovascular disease (CVD)?

A presentation by Simon Griffin, MD, leader of the Prevention of Diabetes and Related Metabolic Disorders in High Risk Groups program at Cambridge University, Cambridge, England, noted that trials have shown that lifestyle interventions alone in patients with Type 2 diabetes (T2D) reduce the risk for cardiovascular (CV) events and death. Similarly, the 30-year follow-up of the Da Qing study found there was a significant reduction in the risk for CV events associated with a lifestyle intervention for people with impaired glucose tolerance.

However, using rosiglitazone to prevent diabetes does not have a beneficial role in reducing the risk for CV events, since “the moment you stop the tablet that lowers glucose, the incidence of diabetes is the same as if you hadn’t given participants the tablet in the first place,” Griffin said. “The more difficult conclusion to swallow is that rosiglitazone actually increases the risk of CV events.” However, “unlike rosiglitazone, metformin appears to have a legacy effect; the moment you stop the tablet, the benefits don’t appear to disappear.”

So, does Metformin reduce CVD in diabetes? To answer this, Griffin cited the results of several meta-analyses:

  • Selvin reported a significant reduction in CV mortality of 26% with metformin, but a nonsignificant 15% reduction in CV morbidity
  • Lamanna reported a nonsignificant 6.3% reduction in CV events and a 10% reduction in the risk for myocardial infarction.
  • Griffin’s group reported an 11% reduction in the risk for myocardial infarction.
  • Minami reported a 48% reduction in CV events and a nonsignificant 20% reduction in all-cause mortality.
  • The UKPDS reported a consistent 31% reduction in the risk for CV events over time associated with metformin.

To find out more, CLICK HERE.

 

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