Metformin and the heart: Update on mechanisms of cardiovascular protection with special reference to comorbid type 2 diabetes and heart failure

Guntram Schernthaner; Kerstin Brand; Clifford J Bailey

doi:10.1016/j.metabol.2022.155160

Metformin and the heart: Update on mechanisms of cardiovascular protection with special reference to comorbid type 2 diabetes and heart failure

Guntram Schernthaner, Kerstin Brand, Clifford J Bailey

College of Health and Life Sciences

Research output: Contribution to journal › Review article › peer-review

Abstract

Metformin has been in clinical use for the management of type 2 diabetes for more than 60 years and is supported by a vast database of clinical experience: this includes evidence for cardioprotection from randomised trials and real-world studies. Recently, the position of metformin as first choice glucose-lowering agent has been supplanted to some extent by the emergence of newer classes of antidiabetic therapy, namely the sodium-glucose co-transporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. These agents have benefitted through support from large cardiovascular outcomes trials with more modern trial designs than earlier studies conducted to assess metformin. Nevertheless, clinical research on metformin continues to further assess its many potentially advantageous effects. Here, we review the evidence for improved cardiovascular outcomes with metformin in the context of the current era of diabetes outcomes trials. Focus is directed towards the potentially cardioprotective actions of metformin in patients with type 2 diabetes and heart failure (HF), now recognised as the most common complication of diabetes. [Abstract copyright: Copyright © 2021. Published by Elsevier Inc.]

Original language	English
Article number	155160
Journal	Metabolism: clinical and experimental
Volume	130
Early online date	7 Feb 2022
DOIs	https://doi.org/10.1016/j.metabol.2022.155160
Publication status	Published - May 2022

Bibliographical note

© 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license. Funding Information: The authors are indebted to Professor Henrik Wiggers, Aarhus University Hospital, Denmark, for advice on studies relevant to the effects of metformin on the failing heart. Dr. Mike Gwilt (GT Communications) provided editorial assistance, funded by Merck Healthcare KGaA , Darmstadt, Germany. Merck Healthcare KGaA, Darmstadt, Germany also funded open access publication and colour reproduction of the figure in this article.

Keywords

Metformin
Cardioprotection
Type 2 diabetes

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10.1016/j.metabol.2022.155160Licence: CC BY-NC-ND 3.0

Metformin and the heart: Update on mechanisms of cardiovascular protection
© 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license
Final published version, 1.99 MBLicence: CC BY-NC-ND 3.0

Cite this

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title = "Metformin and the heart: Update on mechanisms of cardiovascular protection with special reference to comorbid type 2 diabetes and heart failure",

abstract = "Metformin has been in clinical use for the management of type 2 diabetes for more than 60 years and is supported by a vast database of clinical experience: this includes evidence for cardioprotection from randomised trials and real-world studies. Recently, the position of metformin as first choice glucose-lowering agent has been supplanted to some extent by the emergence of newer classes of antidiabetic therapy, namely the sodium-glucose co-transporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. These agents have benefitted through support from large cardiovascular outcomes trials with more modern trial designs than earlier studies conducted to assess metformin. Nevertheless, clinical research on metformin continues to further assess its many potentially advantageous effects. Here, we review the evidence for improved cardiovascular outcomes with metformin in the context of the current era of diabetes outcomes trials. Focus is directed towards the potentially cardioprotective actions of metformin in patients with type 2 diabetes and heart failure (HF), now recognised as the most common complication of diabetes. [Abstract copyright: Copyright {\textcopyright} 2021. Published by Elsevier Inc.]",

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note = "{\textcopyright} 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license. Funding Information: The authors are indebted to Professor Henrik Wiggers, Aarhus University Hospital, Denmark, for advice on studies relevant to the effects of metformin on the failing heart. Dr. Mike Gwilt (GT Communications) provided editorial assistance, funded by Merck Healthcare KGaA , Darmstadt, Germany. Merck Healthcare KGaA, Darmstadt, Germany also funded open access publication and colour reproduction of the figure in this article.",

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AU - Schernthaner, Guntram

AU - Brand, Kerstin

AU - Bailey, Clifford J

N1 - © 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license. Funding Information: The authors are indebted to Professor Henrik Wiggers, Aarhus University Hospital, Denmark, for advice on studies relevant to the effects of metformin on the failing heart. Dr. Mike Gwilt (GT Communications) provided editorial assistance, funded by Merck Healthcare KGaA , Darmstadt, Germany. Merck Healthcare KGaA, Darmstadt, Germany also funded open access publication and colour reproduction of the figure in this article.

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N2 - Metformin has been in clinical use for the management of type 2 diabetes for more than 60 years and is supported by a vast database of clinical experience: this includes evidence for cardioprotection from randomised trials and real-world studies. Recently, the position of metformin as first choice glucose-lowering agent has been supplanted to some extent by the emergence of newer classes of antidiabetic therapy, namely the sodium-glucose co-transporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. These agents have benefitted through support from large cardiovascular outcomes trials with more modern trial designs than earlier studies conducted to assess metformin. Nevertheless, clinical research on metformin continues to further assess its many potentially advantageous effects. Here, we review the evidence for improved cardiovascular outcomes with metformin in the context of the current era of diabetes outcomes trials. Focus is directed towards the potentially cardioprotective actions of metformin in patients with type 2 diabetes and heart failure (HF), now recognised as the most common complication of diabetes. [Abstract copyright: Copyright © 2021. Published by Elsevier Inc.]

AB - Metformin has been in clinical use for the management of type 2 diabetes for more than 60 years and is supported by a vast database of clinical experience: this includes evidence for cardioprotection from randomised trials and real-world studies. Recently, the position of metformin as first choice glucose-lowering agent has been supplanted to some extent by the emergence of newer classes of antidiabetic therapy, namely the sodium-glucose co-transporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. These agents have benefitted through support from large cardiovascular outcomes trials with more modern trial designs than earlier studies conducted to assess metformin. Nevertheless, clinical research on metformin continues to further assess its many potentially advantageous effects. Here, we review the evidence for improved cardiovascular outcomes with metformin in the context of the current era of diabetes outcomes trials. Focus is directed towards the potentially cardioprotective actions of metformin in patients with type 2 diabetes and heart failure (HF), now recognised as the most common complication of diabetes. [Abstract copyright: Copyright © 2021. Published by Elsevier Inc.]

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KW - Cardioprotection

KW - Type 2 diabetes

UR - https://www.sciencedirect.com/science/article/pii/S0026049522000385

U2 - 10.1016/j.metabol.2022.155160

DO - 10.1016/j.metabol.2022.155160

M3 - Review article

C2 - 35143848

VL - 130

JO - Metabolism: clinical and experimental

JF - Metabolism: clinical and experimental

M1 - 155160

ER -

Metformin and the heart: Update on mechanisms of cardiovascular protection with special reference to comorbid type 2 diabetes and heart failure

Abstract

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Keywords

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