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Not Only SGLT-2 Inhibitors to Prevent CVD

May 7, 2019

Author: Steve Freed, R.PH., CDE

Metformin for CVD benefits? Medication taken for type 2 diabetes may also help reverse a potentially life-threatening heart condition.

Researchers say metformin lowers blood pressure, which can help reduce effects of left ventricular hypertrophy. That’s according to recently published research on the commonly prescribed drug.


The study, called the MET-REMODEL Trial, suggests that metformin can reduce left ventricular hypertrophy (LVH) in people who have prediabetes. It’s the first clinical trial to show that metformin can reverse this heart condition, as well as lower blood sugars.

To test the hypothesis that metformin may regress left ventricular hypertrophy (LVH) in patients who have coronary artery disease (CAD), with insulin resistance (IR) and/or pre-diabetes, they randomly assigned 68 patients (mean age 65 ± 8 years) without diabetes who have CAD with IR and/or pre-diabetes to receive either metformin XL (2000 mg daily dose) or placebo for 12 months. Primary endpoint was change in left ventricular mass indexed to height (LVMI), assessed by magnetic resonance imaging. In the modified intention-to-treat analysis (n = 63), metformin treatment significantly reduced LVMI compared with placebo group (absolute mean difference −1.37 (95% confidence interval: −2.63 to −0.12, P = 0.033). Metformin also significantly reduced other secondary study endpoints such as: LVM (P = 0.032), body weight (P = 0.001), subcutaneous adipose tissue (P = 0.024), office systolic blood pressure (BP, P = 0.022) and concentration of thiobarbituric acid reactive substances, a biomarker for oxidative stress (P = 0.04). The glycated hemoglobin A1C concentration and fasting IR index did not differ between study groups at the end of the study.

Changes to the heart were measured by magnetic resonance imaging (MRI). Weight, body fat, and blood pressure were also tracked throughout the study. Only the metformin group experienced improved LVH symptoms, reduced blood pressure, and significant weight loss, the researchers reported.  Lower blood pressure and weight loss are two effective ways to reduce the effects of LVH.

From the results it was concluded that Metformin treatment significantly reduced LVMI, LVM, office systolic BP, body weight, and oxidative stress. Although LVH is a good surrogate marker of cardiovascular (CV) outcome, conclusive evidence for the cardio-protective role of metformin is required from large CV outcomes trials.

It is known that people with a strong family history of LVH are most at risk, and while not everyone with a genetic predisposition will get it, these are the people who should be most carefully screened. In severe cases, blood flow from the heart becomes sufficiently obstructed that a person can faint, and it becomes life-threatening. It’s been associated with increased risk of atrial fibrillation (irregular heartbeat) and sudden death. It has been shown that reducing high blood pressure in the early stages of LVH can help reverse the disease.

So, with the results from the current study we can conclude that metformin helps get the sugar to its proper destination, into the body’s cells, and can also reduce the overall risk of death from heart disease.

The final analysis of more than 200 studies, which included nearly 1.5 million participants, found that metformin reduced the risk of people dying from heart disease by between 30 and 40 percent compared to sulfonylurea, a drug also used to reduce blood sugar levels.

Metformin looks like a clear winner.

Practice Pearls

  • Metformin can improve a condition called left ventricular hypertrophy.
  • Compared with placebo, metformin treatment resulted in a significant reduction of body weight and SBP
  • Previous research also shows that metformin significantly reduces overall risk of death from heart disease.

European Heart Journal, ehz203, https://doi.org/10.1093/eurheartj/ehz203,  Published:  17 April 2019


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