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Metformin Cardiovascular Outcomes

Investigation Of Metformin In Pre-diabetes On Atherosclerotic Cardiovascular Outcomes (va-impact)

Investigation Of Metformin In Pre-diabetes On Atherosclerotic Cardiovascular Outcomes (va-impact)

This research will help us to learn if the medicine called metformin reduces the risk of death, heart attacks, and/or strokes in patients who have pre-diabetes and heart or blood vessel problems. CSP #2002 is a multicenter, prospective, randomized, double blind, secondary prevention trial to test the hypothesis that treatment with metformin, compared with placebo, reduces mortality and cardiovascular morbidity in patients with pre-diabetes and established atherosclerotic cardiovascular disease. Qualifying patients have pre-diabetes defined by HbA1c, fasting blood glucose, and/or oral glucose tolerance test criteria; clinically evident coronary, cerebrovascular, or peripheral arterial atherosclerotic cardiovascular disease; and estimated glomerular filtration rate of at least 45 mL/min/1.73 m2; and do not fulfill any exclusion criteria. Patients who are eligible and agree to participate are randomly assigned to treatment with metformin XR (titrated to a maximum dose of 2000 mg daily based on safety and tolerability) or matching placebo. All patients receive counseling on therapeutic lifestyle recommendations. Study Type : Interventional (Clinical Trial) Estimated Enrollment : 7868 participants Allocation: Randomized Intervention Model: Parallel Assignment Masking: Double (Participant, Investigator) Primary Purpose: Treatment Official Title: CSP #2002 - Investigation of Metformin in Pre-Diabetes on Atherosclerotic Cardiovascular OuTcomes (VA-IMPACT) Anticipated Study Start Date : January 2, 2018 Estimated Primary Completion Date : June 30, 2024 Estimated Study Completion Date : June 30, 2024 Arm Intervention/treatment Experimental: Metformin Participants are randomly assigned in a 1:1 ratio to treatment with metformin XR 500 mg or matching placebo. Drug: Metformin XR For Continue reading >>

Effects Of Metformin Versus Glipizide On Cardiovascular Outcomes In Patients With Type 2 Diabetes And Coronary Artery Disease

Effects Of Metformin Versus Glipizide On Cardiovascular Outcomes In Patients With Type 2 Diabetes And Coronary Artery Disease

OBJECTIVEdThe two major classes of antidiabetic drugs, sulfonylureas and metformin, may differentially affect macrovascular complications and mortality in diabetic patients. We com- pared the long-term effects of glipizide and metformin on the major cardiovascular events in type 2 diabetic patients who had a history of coronary artery disease (CAD). RESEARCH DESIGN AND METHODSdThis study is a multicenter, randomized, double- blind, placebo-controlled clinical trial. A total of 304 type 2 diabetic patients with CAD, mean age = 63.3 years (range, 3680 years), were enrolled. Participants were randomly assignedto receive either glipizide (30 mgdaily) or metformin (1.5g daily) for 3 years. The primary endpoints were times to the composite of recurrent cardiovascular events, including death from a cardiovascular cause, death from any cause, nonfatal myocardial infarction, nonfatal stroke, or arterial revascularization. RESULTSdAt the end of study drug administration, both groups achieved a signicant decrease in the level of glycated hemoglobin (7.1% in the glipizidegroupand7.0%inthemetformingroup).Ata median follow-up of 5.0 years, 91 participants had developed 103 primary end points. Intention-to-treat analysis showed an adjusted hazard ratio (HR) of 0.54 (95% CI 0.300.90; P= 0.026) for the composites of cardiovascular events among the patients that received metformin, compared with glipizide. The secondary end points and adverse events were not signicantly different between the two groups. CONCLUSIONSdTreatment with metformin for 3 years substantially reduced major cardio- vascular events in a median follow-up of 5.0 years compared with glipizide. Our results indicated a potential benet of metformin therapy on cardiovascular outcomes in high-risk patients. in developing st Continue reading >>

Research To Explore Metformin And Type 2 Cardiovascular Disease Link

Research To Explore Metformin And Type 2 Cardiovascular Disease Link

Research to explore metformin and type 2 cardiovascular disease link Increasing the use of electronic health records could hold the key to determining whether metformin reduces the risk of cardiovascular disease among people with type 2 diabetes, according to new research. Metformin is the most-prescribed oral medication to lower blood glucose worldwide. Yet previous systematic reviews have raised doubts about its effectiveness in reducing therisk of cardiovascular disease, the most costly complication of type 2 diabetes. Researchers from the School of Clinical Medicine at the University of Cambridge carried out a study to systematically identify and pool randomised trials reporting cardiovascular outcomes in which the effect of metformin was isolated through comparison to diet, lifestyle or placebo. The study saw the researchers perform an electronic literature search of MEDLINE, EMBASE and the Cochrane Library, manually screening the reference lists of previous meta-analyses of trials of metformin identified through a MEDLINE search. The team included randomised controlled trials of adults with type 2 diabetes comparing any dose and preparation of oral metformin with no intervention, placebo or a lifestyle intervention and reporting mortality or a cardiovascular outcome. The results, published in Diabetologia , are based on 10 articles reporting 13 trials (including a total of 2,079 individuals with type 2 diabetes allocated to metformin and a similar number to comparison groups) of which only four compared metformin with placebo and collected data on cardiovascular outcomes. Researchers said: There remains uncertainty about whether metformin reduces risk of cardiovascular disease among patients with type 2 diabetes, for whom it is the recommended first-line drug. Al Continue reading >>

Antihyperglycemic Drugs And Cardiovascular Outcomes In Type 2 Diabetes

Antihyperglycemic Drugs And Cardiovascular Outcomes In Type 2 Diabetes

Antihyperglycemic drugs and cardiovascular outcomes in type 2 diabetes Cleveland Clinic Journal of Medicine 2016 May; 83 Suppl 1(5):S11-S17 Clinical Research and Adult Diabetes sections, Joslin Diabetes Center, Harvard Medical School, Boston, MA Correspondence: Om P. Ganda, MD, Joslin Diabetes Center, Harvard Medical School, 1 Joslin Place, Boston, MA 02215; [email protected] Dr. Ganda reported research funding from Amarin, consulting fees from Amgen and Sanofi, and speakers honoraria from Merck. ABSTRACTIn patients with diabetes, a complex and controversial relationship exists between intensive glycemic control and cardiovascular (CV) outcomes. Although the value of glucose-lowering agents in preventing microvascular complications associated with diabetes has been established, along with reductions in ischemic coronary events, active treatment in one major glycemic-control trial resulted in an unexplained increase in CV-associated mortality and total deaths compared with controls. Questions of CV safety with specific glucose-lowering agents along with the mechanisms underlying their effects on CV events have not been fully answered, underscoring the need for additional well-designed, long-term randomized controlled trials (RCTs) to prove their CV safety vs an active comparator. The CV benefits of one sodium-glucose cotransporter-2 inhibitor reported in an RCT await confirmation in ongoing trials. Long-term randomized controlled trials have established the value of intensive glycemic control in reducing CV outcomes in patients with type 2 but only after many years of follow-up. Despite reductions in ischemic coronary events, some clinical trials have reported unexplained increases in CV-associated mortality and total deaths in patients receiving intensive gly Continue reading >>

Metformin May Reduce Cardiovascular Risk In Type 2 Diabetes

Metformin May Reduce Cardiovascular Risk In Type 2 Diabetes

Metformin May Reduce Cardiovascular Risk in Type 2 Diabetes by Charles Bankhead Charles Bankhead, Staff Writer, MedPage Today Explain to patients that this study found an association between treatment of diabetes with metformin and a reduced risk of cardiovascular death. Note that the findings came from a retrospective analysis of published studies and therefore do not prove that metformin reduces cardiovascular risk. BALTIMORE, Oct. 27 -- Patients with type 2 diabetes may have a lower risk of cardiovascular death when treated with metformin, results of a meta-analysis suggested. The analysis of 40 randomized clinical trials of antidiabetic drugs revealed a 26% reduction in the relative risk of cardiovascular mortality compared with other drugs or placebo, Elizabeth Selvin, Ph.D., of the Johns Hopkins School of Public Health here, and colleagues reported in the Oct. 27 issue of Archives of Internal Medicine. No other oral diabetes drug was associated with a decreased risk of cardiovascular death, but rosiglitazone (Avandia) was associated with a trend toward higher cardiovascular mortality. The authors emphasized that lack of statistical power precluded firm conclusions about the drugs' effects on cardiovascular risk. "Larger, long-term studies taken to hard endpoints and better reporting of cardiovascular events in short-term studies will be required to draw firm conclusions about major clinical benefits and risks related to oral diabetes agents," they said. Since the 1990s, the options for oral diabetic medications have increased markedly. The expanded selection has created a need for comparative data on the risks and benefits of oral diabetes drugs, particularly in light of the greater cost of newer agents, the authors noted. Clinical trials of oral drugs for diabet Continue reading >>

Cardiovascular Risk Associated With Acarbose Versus Metformin As The First-line Treatment In Patients With Type 2 Diabetes: A Nationwide Cohort Study

Cardiovascular Risk Associated With Acarbose Versus Metformin As The First-line Treatment In Patients With Type 2 Diabetes: A Nationwide Cohort Study

Cardiovascular Risk Associated With Acarbose Versus Metformin as the First-Line Treatment in Patients With Type 2 Diabetes: A Nationwide Cohort Study Institute of Preventive Medicine (C-H.C., S-T.C., L-M.C., M-S.L.), College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine (C-H.C., L-M.C.), Taipei, Taiwan; Department of Medicine (C-H.C., Y-C.C., J-W.L., L-M.C.), College of Medicine, National Taiwan University, Taipei, Taiwan; Search for other works by this author on: Graduate Institute of Medical Genomics and Proteomics (Y-C.C.), National Taiwan University, Taipei, Taiwan; National Taiwan University Hospital, Taipei, Taiwan; Department of Medicine (C-H.C., Y-C.C., J-W.L., L-M.C.), College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine (Y-C.C.), National Taiwan University Hospital, Hsin Chu Branch, HsinChu, Taiwan; Search for other works by this author on: Department of Medicine (C-H.C., Y-C.C., J-W.L., L-M.C.), College of Medicine, National Taiwan University, Taipei, Taiwan; Cardiovascular Center (J-W.L.), National Taiwan University Hospital, Yun-Lin Branch, Dou-Liou City, Yun-Lin County, Taiwan Search for other works by this author on: Institute of Preventive Medicine (C-H.C., S-T.C., L-M.C., M-S.L.), College of Public Health, National Taiwan University, Taipei, Taiwan; Search for other works by this author on: Institute of Preventive Medicine (C-H.C., S-T.C., L-M.C., M-S.L.), College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine (C-H.C., L-M.C.), Taipei, Taiwan; Department of Medicine (C-H.C., Y-C.C., J-W.L., L-M.C.), College of Medicine, National Taiwan University, Taipei, Taiwan; Address all correspondence and requests for reprints Continue reading >>

Metformin May Moderate Ddp-4 Inhibitor Effect On Cardiovascular Outcomes

Metformin May Moderate Ddp-4 Inhibitor Effect On Cardiovascular Outcomes

10-25-2017 | Dipeptidyl peptidase-4 inhibitors | News Metformin may moderate DDP-4 inhibitor effect on cardiovascular outcomes medwireNews: Metformin status at the time of initial dipeptidyl peptidase (DPP) 4 inhibitor use may influence the effect these agents have on cardiovascular outcomes, be it positive or negative, suggest results of a hypothesis-generating meta-analysis. Discussing their findings, the authors note that metformin use is unlikely to be the only difference between these subgroups and suggest that its use may indicate other baseline differences such as rates of chronic kidney disease or congestive heart failure, which should be accounted for in future analyses. Matthew Crowley (Duke University School of Medicine, Durham, North Carolina, USA) and colleagues analysed data from three multinational trials examining the effects of the DPP-4 inhibitors sitagliptin, alogliptin, or saxagliptin versus placebo on cardiovascular outcomes in patients with type 2 diabetes. They found that, overall, DPP-4 inhibition had a neutral effect on the risk for the composite outcome of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke (plus unstable angina hospitalization in one study) during a median follow-up period of 1.5 to 3years. However, when the study participants were grouped according to baseline metformin use, the researchers observed a trend toward improved cardiovascular outcomes with DPP-4 inhibition in individuals who were using metformin at baseline (prevalent users), at a nonsignificant hazard ratio (HR) of 0.92. By contrast, baseline metformin nonusers showed a trend toward an increased risk for cardiovascular events, with a nonsignificant HR of 1.10 reported. Further analysis revealed that the effect DPP-4 inhibition had on cardiov Continue reading >>

Investigation Of Metformin In Pre-diabetes On Atherosclerotic Cardiovascular Outcomes (va-impact)

Investigation Of Metformin In Pre-diabetes On Atherosclerotic Cardiovascular Outcomes (va-impact)

VA Health Care VA Salt Lake City Health Care System Investigation of Metformin in Pre-Diabetes on Atherosclerotic Cardiovascular Outcomes (VA-IMPACT) Investigation of Metformin in Pre-Diabetes on Atherosclerotic Cardiovascular Outcomes (VA-IMPACT) IMPACT is a multicenter, prospective, randomized, double blind, secondary prevention trial to test the hypothesis that treatment with metformin, compared with placebo, reduces mortality and cardiovascular morbidity in patients with pre-diabetes and established atherosclerotic cardiovascular disease. Qualifying patients have pre-diabetes defined by HbA1c, fasting blood glucose, and/or oral glucose tolerance test criteria; clinically evident coronary, cerebrovascular, or peripheral arterial atherosclerotic cardiovascular disease; and estimated glomerular filtration rate of at least 45 mL/min/1.73 m2; and do not fulfill any exclusion criteria. Patients who are eligible and agree to participate are randomly assigned to treatment with metformin XR (titrated to a maximum dose of 2000 mg daily based on safety and tolerability) or matching placebo. All patients receive counseling on therapeutic lifestyle recommendations. Ages Eligible for Study: 18 Years and older Pre-diabetes: This condition is fulfilled by HbA1c of at least 5.7%, but less than 6.5%; two measurements of fasting blood glucose (on separate days) of 100-125 mg/dL; or a 2-hour blood glucose level of 140-199 mg/dL following a 75 g glucose load oral glucose tolerance test. These criteria must be met in the absence of diabetic treatment. For a participant to qualify with pre-diabetes on the basis of HbA1c or oral glucose tolerance testing, the results must have been obtained within 5 months prior to the date of the screening visit, to ensure that the data are no more than Continue reading >>

Cardiovascular Impact Of Drugs Used In The Treatment Of Diabetes

Cardiovascular Impact Of Drugs Used In The Treatment Of Diabetes

Go to: Introduction The global impact of obesity and diabetes continues to increase and negatively affect morbidity, mortality and health care budgets. Reports in 2011 from the International Diabetes Federation [IDF, 2013] stated that there was an estimated 285 million people worldwide who had already been diagnosed with diabetes and that the worldwide prevalence of diabetes has truly reached pandemic levels [Chen et al. 2011; Zimmet, 2011]. Furthermore, increases in the prevalence of diabetes for all age groups worldwide are predicted, with total numbers to reach approximately 450 million in 2030 amounting to 7% of the population of the world. The most recent estimate predicts 592 million in 2035 or approximately 10% of the total population [Chen et al. 2011; Zimmet, 2011; IDF, 2013]. A serious concern is for developing countries where it is predicted there will be a 69% increase in the number of adults with diabetes compared with so-called developed countries where a 20% increase is anticipated [Shaw et al. 2010]. Type 2 diabetes (T2D) accounts for approximately 90% of all cases of adult-onset diabetes and the increase in the prevalence of T2D and associated insulin resistance can be linked to a rise in obesity resulting from a combination of lifestyle changes and genetic susceptibility [Daousi et al. 2006]. A natural consequence of an increased incidence in diabetes is the high likelihood that this will be accompanied by a marked rise in the occurrence of cardiovascular disease [Nolan et al. 2011]. Although the aetiology of vascular dysfunction in diabetes has been extensively investigated we still have not optimized the therapeutic management of diabetes such that the cardiovascular system is appropriately protected. It is also very important to emphasize that diabe Continue reading >>

Little Known About Impact Of Widely Prescribed Diabetes Drug, Metformin, On Cardiovascular Disease

Little Known About Impact Of Widely Prescribed Diabetes Drug, Metformin, On Cardiovascular Disease

Little known about impact of widely prescribed diabetes drug, metformin, on cardiovascular disease Metformin is the most-prescribed oral medication to lower blood glucose worldwide. But research findings about its association with cardiovascular disease, the most costly complication of type 2 diabetes, remain sparse and difficult to interpret. A new meta-analysis of research on the effect of metformin on cardiovascular outcomes in diabetes patients shows that metformin monotherapy appears safe and, while there is a suggestion of benefit, there remains uncertainty about whether it reduces risk of cardiovascular disease. The review indicates that metformin may reduce risk of all-cause mortality by up to 16% but it could increase risk of stroke by up to 48%. The review, from Professor Simon Griffin, Dr Greg Irving and Dr James Leaver at the Primary Care Unit, was published in Diabetologia within the series of articles commissioned to mark the 60th anniversary of the first clinical use of metformin in diabetes. In spite of the long history and enormous reach of this drug, the authors found only 13 studies reporting cardiovascular outcomes in which the effect of metformin was isolated through comparison to diet, lifestyle or placebo. The studies included just over 2000 patients with type 2 diabetes allocated to metformin. Only four randomised-controlled cardiovascular endpoint trials simply compared metformin with placebo among patients with type 2 diabetes.These small studies took place among relatively young, overweight/obese, North American and Northern European patients with poorly controlled diabetes in contrast to some newer treatments. So, while metformin demonstrates cardiovascular safety as per the 2008 FDA guidance, its use for prevention of cardiovascular disease Continue reading >>

Ada: Cardiovascular Benefits Seen With Long-term Metformin Use In Adults With Type 1 Diabetes

Ada: Cardiovascular Benefits Seen With Long-term Metformin Use In Adults With Type 1 Diabetes

Home / Conditions / Type 1 Diabetes / ADA: Cardiovascular Benefits seen with Long-Term Metformin Use in Adults with Type 1 Diabetes ADA: Cardiovascular Benefits seen with Long-Term Metformin Use in Adults with Type 1 Diabetes Results from the REMOVAL trial revealed reduction in the risk of cardiovascular disease among other benefits with metformin in type 1 diabetes patients. Atherosclerosis leads to macrovascular complications in diabetes. These complications contribute to the majority of deaths in patients with diabetes. The use of metformin in previous studies have established a reduction in risk of cardiovascular disease in patients with type 2 diabetes. This is one of the reasons why metformin is currently recommended as first line therapy for these patients. However, it is only recommended for off label use in overweight or obese patients with type 1 diabetes to assist in weight loss and to decrease insulin dose requirements. Researchers wanted to investigate the potential use of metformin in patients with type 1 diabetes, to evaluate if these patients could also benefit from the reduction in risk of cardiovascular disease. An international, double-blind study called the REducing with MetfOrmin Vascular Adverse Lesions (REMOVAL) study enrolled 493 participants over the age of 40 with a minimum of five year duration of type 1 diabetes and at least three cardiovascular risk factors. The ten defined risk factors in the study include known CVD, strong family history of CVD, diabetes duration > 20 years, a BMI 28 kg/m2, HbA1c > 8.0%, current smoker, microalbuminuria, eGFR < 90 mL/min/1.732, hypertension and dyslipidemia. After a 3 month run in period, 428 participants were randomized to receive either placebo or 1000 mg of metformin twice a day. All baseline character Continue reading >>

Impact Of Metformin On Cardiovascular Disease: A Meta-analysis Of Randomised Trials Among People With Type 2 Diabetes

Impact Of Metformin On Cardiovascular Disease: A Meta-analysis Of Randomised Trials Among People With Type 2 Diabetes

Impact of metformin on cardiovascular disease: a meta-analysis of randomised trials among people with type 2 diabetes 1,2 James K. Leaver ,1 and Greg J. Irving 1 1The Primary Care Unit, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR UK 2MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK 1The Primary Care Unit, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR UK 1The Primary Care Unit, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR UK 1The Primary Care Unit, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR UK 2MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK Simon J. Griffin, Email: [email protected] . Received 2017 Apr 21; Accepted 2017 May 24. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. This article has been cited by other articles in PMC. Metformin is the most-prescribed oral medication to lower blood glucose worldwide. Yet previous systematic reviews have raised doubts about its effectiveness in r Continue reading >>

Study Finds Few Beneficial Effects Of Metformin Drug For Cardiovascular Disease In People Without Diabetes

Study Finds Few Beneficial Effects Of Metformin Drug For Cardiovascular Disease In People Without Diabetes

Study finds few beneficial effects of metformin drug for cardiovascular disease in people without diabetes Despite high expectations for the commonly used diabetes drug metformin to improve risk factors for heart disease in people without diabetes, few beneficial effects have been found in a randomised trial of patients with established cardiovascular disease, published in The Lancet Diabetes & Endocrinology. "There has been a lot of anticipation based on research in diabetic patients suggesting that metformin has cardiovascular benefits beyond its effects on blood glucose. We were hoping to find that it might also prevent hardening of the arteries, a warning sign for future heart attacks and strokes, in people without diabetes already on a statin, explains study leader Dr David Preiss from the University of Glasgow in the UK. Metformin is a safe, inexpensive drug that is recommended as the first-line treatment for people with type 2 diabetes. It works by reducing the overactive glucose production associated with diabetes but it has also been shown to reduce other related risk factors for heart disease such as cholesterol levels, and inflammatory and blood clotting markers in earlier studies conducted before the common use of statins. The landmark UKPDS trial found that metformin treatment led to a 39% reduction in risk of heart attack over 10 years in diabetic patients, but whether its potential cardiovascular benefits could be replicated in individuals without diabetes had not been tested until now. The Carotid Atherosclerosis: MEtformin for insulin ResistAnce (CAMERA) trial, was designed to investigate the effect of metformin on changes in carotid intima-media thickness (cIMT; an established marker of atherosclerosis) in non-diabetic individuals with heart disease t Continue reading >>

Effect Of Metformin Monotherapy On Cardiovascular Diseases And Mortality: A Retrospective Cohort Study On Chinese Type 2 Diabetes Mellitus Patients

Effect Of Metformin Monotherapy On Cardiovascular Diseases And Mortality: A Retrospective Cohort Study On Chinese Type 2 Diabetes Mellitus Patients

Effect of metformin monotherapy on cardiovascular diseases and mortality: a retrospective cohort study on Chinese type 2 diabetes mellitus patients Many factors influence whether the first-line oral anti-diabetic drug, metformin, should be initiated to a patient with type 2 diabetes mellitus (T2DM) early in the course of management in addition to lifestyle modifications. This study aims to evaluate the net effects of metformin monotherapy (MM) on the all-cause mortality and cardiovascular disease (CVD) events. A retrospective 5-year follow-up cohort study was conducted on Chinese adult patients with T2DM and without any CVD history under public primary care. Cox proportional hazard regressions were performed to compare the risk of all-cause mortality and CVD events (CHD, stroke, heart failure) between patients receiving lifestyle modifications plus MM (MM groups) and those with lifestyle modifications alone (control groups). 3400 pairs of matched patients were compared. MM group had an incidence rate of 7.5 deaths and 11.3 CVD events per 1000 person-years during a median follow-up period of 62.5months whereas control group had 11.1 deaths and 16.3 per 1000 person-years during a median follow-up period of 43.544.5months. MM group showed a 29.5 and 3035% risk reduction of all-cause mortality and CVD events (except heart failure) than control group (P<0.001). MM group was more prone to progress to chronic kidney disease but this was not statistically significant. Type 2 diabetic patients who were started on metformin monotherapy showed improvement in many of the clinical parameters and a reduction in all-cause mortality and CVD events than lifestyle modifications alone. If there is no contraindication and if tolerated, diabetic patients should be prescribed with metformin Continue reading >>

Metformin And Vascular Protection: A Cardiologist's View - Em|consulte

Metformin And Vascular Protection: A Cardiologist's View - Em|consulte

Metformin and vascular protection: a cardiologist's view [1]Leducq Center for Cardiovascular Research, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital,Harvard Medical School, Boston, USA. [2]MD, Leducq Center for Cardiovascular Research, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave. EBRC 307, Boston. MA 02115, USA. Phone: +1 617 278 0087 Fax: +1 617 732 6961 E-mail: The predicted global epidemic of type 2 diabetes highlights the importance of identifying the most effective ways to reduce the risk of long-term diabetic complications. Although hyperglycaemia is undoubtedly a risk factor for microvascular complications, intensive glycaemic management has delivered only modest improvements in macrovascular endpoints thus far. A multidisciplinary approach addressing the components of the dysmetabolic syndrome, including insulin resistance, dyslipidaemia, hypertension, obesity and impaired fibrinolysis, will be required to protect the cardiovascular system more effectively. The potential vascular protective effects of metformin, demonstrated by the UK Prospective Diabetes Study, may complement other strategies within such a framework. Keywords: Metformin , Type 2 diabetes , Cardiovascular disease , Metabolic syndrome Decades of intensive research into the pathophysiology and management of type 2 diabetes leave us with a better understanding of its aetiology and prognosis than ever before. Nevertheless, we still have much to learn, as our current projections of the future burden of type 2 diabetes (summarised elsewhere in this supplement) make grim reading. Indeed, the prevalence of type 2 diabetes is increasing in virtually all populations and appears with escalating frequency in children and adolescents. We Continue reading >>

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