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Metformin deemed safe for patients with diabetes, HF
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Metformin appears to be safe for use in patients with diabetes and advanced heart failure, according to new study findings.
The study followed 401 patients diagnosed with type 2 diabetes and advanced systolic HF between 1994 and 2008. Participants were divided into two groups based on the presence or absence of metformin. The mean age of the cohort was 56 years. Mean left ventricular ejection fraction 24%. According to New York Heart Association classification, 42% were stage III and 45% stage IV.
Both groups were comparable in age, sex, baseline left ventricular ejection fraction, medical history and glycosylated hemoglobin at baseline. Patients treated with metformin had higher BMI, lower creatinine, and were less often administered insulin.
Ninety-nine patients (25%) were administered metformin therapy. The cohort was followed for 14 years in a comprehensive HF management program.
After one year, the survival rate was 91% among metformin-treated patients and 76% among non-metformin-treated patients (RR=0.37; 95% CI, 0.18-0.76).
Multivariate adjustment for demographics, cardiac function, renal function and HF medications revealed a nonsignificant trend for improved survival with metformin therapy.
“Experimental studies suggest that metformin improves myocardial function via activation of a signaling mechanism (AMP-activated protein kinase) independent of antihyperglycemic effects,” Gregg C. Fonarow, MD, Eliot Corday professor of cardiovascular medicine at UCLA, said in a press release. “Together, these studies suggest hat metformin may be cardioprotective by augmenting heart function at the molecular level, and should be further investigated as a treatment for HF, irrespective of diabetes.”
Tamara B. Horwich, MD, MS, assistant professor of medicine at David Geffen School of Medicine at UCLA, said some physicians are reluctant to use metformin in this patient population.
“The diabetes drug metformin previously carried a ‘black box warning’ from the FDA against its use in treating diabetes in HF patients,” she said. “However, our analysis shows that using metformin to treat diabetes in patients with advanced systolic HF is not only safe but may also play a role in improving outcomes compared to conventional diabetes care.”
Shah D. J Card Fail. 2009;doi:10.1016/j.cardfail.2009.10.022.