Metformin therapy and prognosis of patients with heart failure and new-onset diabetes mellitus. A propensity-matched study in the community

Romero, Sotero P.; Andrey, José L.; Garcia-Egido, Antonio; Escobar, Miguel A.; Pérez, Virginia; Corzo, Ramón; Garcia-Domiguez, Gloria J.; Gómez, Francisco

doi:10.1016/j.ijcard.2011.10.141

Cited by 61 publications

(59 citation statements)

References 28 publications

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“…[134][135][136] In addition, multiple observational studies in patients with diabetes mellitus and established HF have suggested that metformin not only may be safe but also may be associated with improved survival in patients with diabetes mellitus and HF. [137][138][139][140][141][142][143][144][145] Animal studies in HF models have also demonstrated potential cardioprotective effects of metformin therapy on the progression of HF via activation of AMP-activated protein kinase pathways, [146][147][148][149] inhibition of cardiac fibrosis, 148,150 and modulation of cardiomyocyte autophagy. 147 It is important to note that prospective, large outcome trials assessing the safety and efficacy of metformin in patients with established HF have not been performed.…”

Section: Safety and Efficacy Of Antihyperglycemic Drugs In Patients Wmentioning

confidence: 99%

Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

Bozkurt¹,

Aguilar²,

Deswal³

et al. 2016

Circulation

349

220

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CLINICAL STATEMENTS AND GUIDELINESfailed to show a significant reduction of SBP in patients with resistant hypertension. 81 Other strategies such as targeting excessive sympathetic nerve activity by carotid body denervation are awaiting clinical validation in the hypertension and HF populations. Drugs to Avoid in Patients With HFSeveral classes of drugs should be avoided in patients with HFrEF with a history of hypertension. Because of their negative inotropic properties and the increased likelihood of worsening HF symptoms, the nondihydropyridine calcium channel blockers such as diltiazem and verapamil should be avoided. 8 The dihydropyridine calcium channel blocker amlodipine appeared to be safe in patients with severe HFrEF in the PRAISE trial (Prospective Randomized Amlodipine Survival Evaluation), 82 as was felodipine. 73 In the current 2013 HF guidelines, most calcium channelblocking drugs except amlodipine are not recommended. 8Although clonidine is an effective antihypertensive agent, a similar centrally acting drug, moxonidine, was associated with increased mortality in patients with HF; thus, centrally acting norepinephrine-depleting agents may need to be avoided or used with caution in patients with HFrEF. 83In the ALLHAT trial, the α-blocker doxazosin arm of the trial was discontinued because of a 2-fold increase in the risk of developing HF compared with chlorthalidone treatment. 45 Although the ALLHAT study excluded patients with established HF and there are caveats about extrapolating these data to the management of hypertension in patients with established HF, the safety and efficacy of α-blockers in the management of patients with HF with hypertension are currently unclear. Potent direct-acting vasodilators such as minoxidil should also be avoided because of their renin-related salt and fluid-retaining effects. Nonsteroidal anti-inflammatory agents should be used with caution in these patients, given their effects on BP, volume status, and renal function. Treatment of Hypertension in Patients With HF With Preserved LVEFMost patients with HF and preserved LVEF (HFpEF), especially elderly women, have hypertension. A significant proportion of these patients also have evidence of LV hypertrophy, and some may have atrial dilatation, cardiac enlargement, and wall motion abnormalities without LV systolic dysfunction. Patients with HFpEF may respond particularly well to the treatment of hypertension with regression of hypertrophy 84 and improvement in filling pressures. 84,85 Most patients with HFpEF require treatment with cardiac medications for the comorbidities of hypertension, diabetes mellitus, coronary artery disease, and atrial fibrillation. The 2013 HF guidelines suggest that the use of β-blocking agents, ACE inhibitors, and ARBs in patients with hypertension is reasonable to control BP in patients with HFpEF. 8 The use of ARBs might also be considered to decrease hospitalizations for patients with HFpEF. recommendations Harmonized With Existing Guidelines for the recognition and Treatment of pa...

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Section: Safety and Efficacy Of Antihyperglycemic Drugs In Patients Wmentioning

confidence: 99%

Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

Bozkurt¹,

Aguilar²,

Deswal³

et al. 2016

Circulation

349

220

View full text Add to dashboard Cite

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“…One potential explanation may be related to the ability of metformin to inhibit de novo lipogenesis in the liver, thereby reducing FA delivery to the heart (39). There is a growing body of evidence that metformin may be beneficial for the treatment of HF in the setting of diabetes (33,43,75,80,82); however, the majority of human study data comes from nonrandomized retrospective analyses. Future investigation will be necessary to determine whether reducing mitochondrial FA flux, and in particular metformin, improves cardiac function and/or outcomes in diabetics.…”

Section: Metabolic Modulationmentioning

confidence: 99%

The Mitochondria in Diabetic Heart Failure: From Pathogenesis to Therapeutic Promise

Schilling

2015

Antioxidants & Redox Signaling

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Significance: Diabetes is an important risk factor for the development of heart failure (HF). Given the increasing prevalence of diabetes in the population, strategies are needed to reduce the burden of HF in these patients. Recent Advances: Diabetes is associated with several pathologic findings in the heart including dysregulated metabolism, lipid accumulation, oxidative stress, and inflammation. Emerging evidence suggests that mitochondrial dysfunction may be a central mediator of these pathologic responses. The development of therapeutic approaches targeting mitochondrial biology holds promise for the management of HF in diabetic patients. Critical Issues: Despite significant data implicating mitochondrial pathology in diabetic cardiomyopathy, the optimal pharmacologic approach to improve mitochondrial function remains undefined. Future Directions: Detailed mechanistic studies coupled with more robust clinical phenotyping will be necessary to develop novel approaches to improve cardiac function in diabetes. Moreover, understanding the interplay between diabetes and other cardiac stressors (hypertension, ischemia, and valvular disease) will be of the utmost importance for clinical translation of scientific discoveries made in this field. Antioxid. Redox Signal. 22, 1515Signal. 22, -1526

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“…In comparison to the metformin user, non-metformin-treated patients were at significantly increased risk for the combined end point of death or urgent transplantation [10]. Likewise, metformin therapy reduced the mortality of heart failure patients with new-onset diabetes mellitus [11]. These studies support an observational study indicating that thiazolidinediones and metformin are not associated with increased mortality rate and may improve outcomes in older patients with diabetes and heart failure [12].…”

Section: Metformin’s Effect On Survival In Humansmentioning

confidence: 85%

Renoprotective Effects of Metformin

Broe

Kajbaf

Lalau

2017

Nephron

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Background/Aims: It has become clear that metformin exerts pleiotropic actions beyond its glucose-lowering agent effect. In this review, we summarise the state of the art concerning the potential renoprotective effects of metformin in vitro, animal models and clinical nephrology. Methods: A literature search was performed in PUBMED, ScienceDirect, between January 1957 and March 2017 using the following keywords: “metformin,” “nephroprotection,” “renoprotection,” “survival,” “renal failure,” “chronic kidney diseases,” “fibrosis,” “polycystic kidney disease” and “microalbuminuria.” Results: A recent review of 17 observational studies concluded that metformin use appeared associated with reduced all-cause mortality in patients with CKD. Metformin has been shown to exert positive effects on the kidney in vitro and animal models representing different types of renal diseases, from acute kidney injury to chronic kidney disease. A retrospective cohort study from the Scientific Registry of Transplant Recipients indicated that metformin was associated with lower adjusted hazards for living donor and deceased donor allograft survival at 3 years posttransplant, and with lower mortality. Conclusion: Based on experimental evidence and some relevant clinical observations, metformin seems to be a promising drug in the treatment of progressive renal damage. RCT studies are the next essential step.

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Metformin therapy and prognosis of patients with heart failure and new-onset diabetes mellitus. A propensity-matched study in the community

Cited by 61 publications

References 28 publications

Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

The Mitochondria in Diabetic Heart Failure: From Pathogenesis to Therapeutic Promise

Renoprotective Effects of Metformin

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