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Beyond Type 2 Diabetes Metformin May Also Offer Heart Benefits
Beyond Type 2 Diabetes Metformin May Also Offer Heart Benefits
The ongoing VA-IMPACT trial will assess metformin for people with prediabetes and
ASCVD.
drug metformin may offer CV benefits that do not depend on the presence of diabetes, and an
A traditional view of separate therapies for diabetes and CVD was challenged after large
randomized controlled trials demonstrated CV benefits for two classes of drugs, SGLT2
inhibitors and GLP-1 receptor agonists, which are “arguably both diabetes and cardiovascular
drugs,” Gregory G. Schwartz, MD, PhD, professor of medicine at the University of Colorado
School of Medicine and chief of the cardiology section at Rocky Mountain Regional VA
Medical Center in Aurora, Colorado, said during a presentation at the American Society for
Clinical evidence from some human studies suggest CV and other benefits. In the
unmasked United Kingdom Prospective Diabetes Study (UKPDS) study, which
formed the basis for metformin’s prevalent use, researchers compared metformin
(n = 342) with usual care (n = 411) in people with new-onset type 2 diabetes and
observed a reduction in CV events, diabetes-related complications and all-cause
mortality in the metformin arm.
“There was a lot of crossover within the groups between metformin and physical
activity and lifestyle, so it is hard to draw an inference,” Schwartz said. “Does
metformin reduce death and CV morbidity? I would say based on the data I shared,
we have equipoise on this question, despite 65 years of use of this drug. When we
have equipoise, we need a randomized, placebo-controlled clinical trial to tell us:
Is this drug worth using in our patients or not?”
“The rationale for this group is that people with prediabetes and ASCVD have a
high risk and, unlike placebo-controlled trials in patients with established diabetes,
there is less need to use an alternative agent in the control group when you study
people with prediabetes,” Schwartz said. “The confounding that is potentially
present in most diabetes trials by the differential use of non-test agents is
diminished when a prediabetes population is studied.”
“Hopefully we will have two new sets of data to answer the question at hand,”
Schwartz said. “Is metformin a CV drug? Stay tuned and hopefully we will have
the answer in a few years.”
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