Metformin beneficial in nondiabetic MetS patients with diastolic dysfunction

Use of metformin, in addition to lifestyle counselling, appears to improve diastolic function in nondiabetic patients with metabolic syndrome (MetS), a study has shown.

A total of 54 nondiabetic adults with MetS and diastolic dysfunction were randomized to undergo lifestyle counselling alone or with metformin (target dose 1,000 mg twice a day). The primary outcome was diastolic function, assessed as the change in mean e’ velocity (measured at baseline, 6, 12, and 24 months). Secondary outcomes included improvements in insulin resistance, functional capacity, and quality of life (QoL).

Of the patients, 49 were included in the modified intention-to-treat (mITT) analysis (mean age 51.8 years, 55 percent male). Metformin treatment produced a substantial decrease in Homeostatic Model Assessment for Insulin Resistance (HOMA-IR).

Linear mixed effects modelling showed a significant between-group difference in diastolic function during the study period, in favour of the metformin arm. The mean change in e’ velocity at 24 months was 0.67 cm/s in the metformin arm vs −0.33 cm/s in the control arm in the mITT population. The corresponding changes in the PP population were 0.80 vs −0.37 cm/s.

Finally, peak oxygen uptake and short form [SF]-36 scores were comparable in the two treatment arms.

Metformin is the most widely used oral glucose-lowering drug among patients with type 2 diabetes. There are several studies reporting that the drug has direct cardioprotective effects, improving diastolic function in diabetic patients undergoing coronary angiography, reducing capillary wedge pressure and left ventricular end-diastolic pressure in dogs, and lowering left ventricular end-diastolic pressure in a nondiabetic rat model. [PLoS One 2016;11:e0168340]