Physicians' Academy for Cardiovascular Education

Metformin may protect against coronary atherosclerosis in men with prediabetes

Effect of Long-Term Metformin and Lifestyle in the Diabetes Prevention Program and its Outcome Study on Coronary Artery Calcium

Goldberg RB, Aroda VR, Bluemke DA, et al, on behalf of the Diabetes Prevention Program Research Group - Circulation 2017; published online ahead of print

Background

The Diabetes Prevention Program (DPP) and its Outcome Study (DPPOS) are evaluating the effects of therapeutic interventions on long-term health outcomes in subjects with prediabetes. So far it was shown that intensive lifestyle change or metformin treatment reduce the incidence of diabetes and the CVD risk in subjects at high risk for diabetes [1-3].

Coronary artery calcium (CAC) is an early marker of subclinical coronary atherosclerosis and predicts CHD events in individuals at high CHD risk, with or without diabetes [4,5].

In this analysis, the DPP/DPPOS treatment effects on CAC measurements were assessed, using CAC severity, derived from the logarithmically transformed CAC score ([log(CAC+1)]) as the primary measure, and the presence of CAC (CAC>0) as the secondary measure.

Main results

Conclusion

In the Diabetes Prevention Program and its Outcome Study, men, but not women with prediabetes treated with metformin for an average duration of 14 years had lower coronary calcium scores compared with the placebo group. No difference in coronary calcium scores was observed in the group receiving a lifestyle intervention as compared to the placebo group. These findings provide evidence that metformin may protect against coronary atherosclerosis in men with prediabetes.

References

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Find this article online at Circulation