Egypt: Metformin Treatment in Heart Failure Patients

Metformin treatment in heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) prevented the increase in left ventricular mass index (LVMI) and improved total antioxidant capacity (TAC) compared with the standard of care (SOC), a recent study has revealed.

"These effects of metformin warrant further research in heart failure patients without diabetes to explore the potential benefits of metformin," the researchers wrote in their study published in Metabolic Syndrome and Related Disorders.

Background

There has been an increasing interest in metformin use in cardiovascular diseases (CVDs) and its potential new roles. Only two randomized controlled trials (RCTs) investigated metformin's effect in nondiabetic HF patients. However, none of these studies evaluated metformin's role in reducing oxidative stress. Ahmed M. Kamel, Cairo University, Kasr El Ainy, Cairo, Egypt, and colleagues hypothesized that metformin might improve left ventricular remodelling and oxidative stress in nondiabetic HF patients with reduced ejection fraction (HFrEF).

Study Details

The study included seventy patients with HFrEF (EF 37% ± 8%; median age 66 years). 35 were randomized to metformin or 35 to standard of care for HF for 6 months in addition to standard therapy. Outcomes of the study included the difference in the change (Δ) in total antioxidant capacity (TAC) and malondialdehyde (MDA), both evaluated colourimetrically and LVMI assessed through transthoracic echocardiography.

Findings

• Compared with the SOC, metformin treatment increased TAC [Δ = 0.12 mmol/L].
• TAC increased significantly only in the metformin group (0.90 ± 0.08 mmol/L at baseline versus 1.04 ± 0.99 mmol/L at 6 months).
• Metformin therapy preserved LVMI (Δ = -23 g/m²) and reduced fasting plasma glucose (Δ = -6.16) compared with the SOC.
• Results did not change after adjusting for baseline values.
• Changes in MDA, left ventricular ejection fraction, and blood pressure were not significantly different between groups.

"Metformin treatment in nondiabetic heart failure patients prevented the increase in LVMI and improved TAC compared with the standard of care," the researchers wrote. "These effects of metformin warrant further research in non-diabetic HF patients to explore the potential benefits of metformin."

Reference

Ahmed M. Kamel, Batool Ismail, Gamal Abdel Hafiz, Nirmeen Sabry, and Samar Farid. Effect of Metformin on Oxidative Stress and Left Ventricular Geometry in Nondiabetic Heart Failure Patients: A Randomized Controlled Trial. Metabolic Syndrome and Related Disorders. ahead of print http://doi.org/10.1089/met.2023.0164