Bailey Clifford J
School of Life and Health Sciences, Aston University, Birmingham, UK.
Cardiovasc Drugs Ther. 2008 Jun;22(3):215-24. doi: 10.1007/s10557-008-6092-0. Epub 2008 Feb 21.
The antihyperglycaemic agent metformin is widely used in the treatment of type 2 diabetes. Data from the UK Prospective Diabetes Study and retrospective analyses of large healthcare databases concur that metformin reduces the incidence of myocardial infarction and increases survival in these patients. This apparently vasoprotective effect appears to be independent of the blood glucose-lowering efficacy.
Metformin has long been known to reduce the development of atherosclerotic lesions in animal models, and clinical studies have shown the drug to reduce surrogate measures such as carotid intima-media thickness. The anti-atherogenic effects of metformin include reductions in insulin resistance, hyperinsulinaemia and obesity. There may be modest favourable effects against dyslipidaemia, reductions in pro-inflammatory cytokines and monocyte adhesion molecules, and improved glycation status, benefiting endothelial function in the macro- and micro-vasculature. Additionally metformin exerts anti-thrombotic effects, contributing to overall reductions in athero-thrombotic risk in type 2 diabetic patients.
抗高血糖药物二甲双胍广泛用于治疗2型糖尿病。英国前瞻性糖尿病研究的数据以及对大型医疗数据库的回顾性分析均表明，二甲双胍可降低心肌梗死的发生率并提高这些患者的生存率。这种明显的血管保护作用似乎独立于其降血糖功效。
长期以来已知二甲双胍可减少动物模型中动脉粥样硬化病变的发展，临床研究表明该药物可降低诸如颈动脉内膜中层厚度等替代指标。二甲双胍的抗动脉粥样硬化作用包括降低胰岛素抵抗、高胰岛素血症和肥胖。可能对血脂异常有适度的有利影响，可降低促炎细胞因子和单核细胞粘附分子水平，并改善糖基化状态，从而有益于大血管和微血管的内皮功能。此外，二甲双胍具有抗血栓形成作用，有助于总体降低2型糖尿病患者的动脉粥样硬化血栓形成风险。
