A randomized controlled trial of metformin on left ventricular hypertrophy in patients with coronary artery disease without diabetes: the MET-REMODEL trial

Mohapradeep Mohan, Shaween Al-Talabany, Angela McKinnie, Ify Mordi, Jagdeep Singh, Stephen Gandy, Fatima Baig, Muhammad S . Hussain, U. Bhalraam, Faisel Khan, Anna Choy, Shona Matthew, Graeme Houston, Allan Struthers, Jacob George, Chim C. Lang (Lead / Corresponding author)

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21 Citations (Scopus)
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Abstract

Aim: We tested 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.

Methods and results: We 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 height1.7 (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 haemoglobin A1C concentration and fasting IR index did not differ between study groups at the end of the study.

Conclusion: 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.

Original languageEnglish
Pages (from-to)3409-3417
Number of pages9
JournalEuropean Heart Journal
Volume40
Issue number41
Early online date17 Apr 2019
DOIs
Publication statusPublished - 1 Nov 2019

Keywords

  • Coronary artery disease
  • Insulin resistance
  • Left ventricular mass
  • Metformin
  • Oxidative stress
  • Pre-diabetes

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