Study shows metformin may provide cardiovascular benefits to patients with CKD, obesity
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Results from a randomized controlled trial showed that metformin provided cardiovascular benefits to patients with chronic kidney disease and metabolic syndrome.
The data, which were related to patients with pre-diabetes, were presented at the virtual ASN Kidney Week.
According to Everly Ramos, MD, of Vanderbilt University Medical Center, patients with CKD have “unacceptably high” cardiovascular mortality rates and that this cannot be explained entirely by the traditional risk factors associated with CKD. Therefore, she contended, there is a growing focus on exploring non-traditional risk factors, such as insulin resistance, systemic inflammation, oxidative stress, obesity and endothelial dysfunction.
“Insulin resistance is common in CKD patients,” Ramos said. “A study by Pham and colleagues from 2012 showed that for every 10 mL/min decrease in eGFR, there is a 2.2% higher fasting insulin concentration and a 1.1% lower insulin sensitivity index. This insulin resistance is predictive of cardiovascular and all-cause mortality in non-diabetic ESRD patients which was shown in a study in 2002.”
Though metformin is currently the first-line treatment for diabetes in patients with CKD stage 3, Ramos said it is unknown whether the drug can also improve subclinical markers of cardiovascular disease in patients with obesity, moderate CKD and pre-diabetes.
To investigate, Ramos and colleagues randomized 50 patients with CKD, metabolic syndrome and/or pre-diabetes to metformin or placebo for 16 weeks (mean age, 65 years; mean BMI, 31.4 kg/m2; 80% were men). The initial dosing was 500 mg per day.
The researchers determined metformin improved brachial artery flow-mediated dilation (from 6.24% at baseline to 12.06% at 16 weeks).
No changes were observed in aortic pulse-wave velocity or carotid intimal medial thickness with the drug.
“This study suggests that metformin has cardiovascular benefits for patients with pre-diabetes or metabolic syndrome,” Ramos concluded of the findings. “Studies of longer duration and larger sample sizes are needed to confirm the beneficial effect of metformin on vascular health among CKD stage 3 patients.”
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Ramos E, et al. Paper FR-OR20. Presented at: ASN Kidney Week. Oct. 22-25, 2020 (virtual meeting).
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