Evaluating the Potential Benefits of Metformin in Patients with Cardiovascular Disease and Heart Failure

OBJECTIVE: To examine the safety and potential benefits of metformin in diabetic patients with cardiovascular (CV) disease and heart failure (HF).

DATA SOURCES: Searches of MEDLINE and International Pharmaceutical Abstracts (1966-August 2012). Search terms included metformin, lactic acidosis, cardiovascular disease, diabetes, heart failure, and clinical trials.

STUDY SELECTION AND DATA EXTRACTION: Published studies and case reports that were chosen for inclusion evaluated the benefit and safety of metformin in patients with diabetes with CV disease and HF.

DATA SYNTHESIS: Case reports and retrospective trials have failed to illustrate an association with metformin use and lactic acidosis in patients with HF or cardiac disease. In fact, the evidence has suggested that these patients may actually benefit from the use of metformin.

CONCLUSIONS: Results from recent trials have evaluated the potential clinical advantages of metformin in patients with cardiac disease and HF. These studies have illustrated a favorable morbidity and mortality profile for the use of metformin in these patient populations. While large prospective trials are still needed to display conclusive evidence, the recent clinical trials suggest a benefit in areas where metformin use has previously been discouraged.