Dludla Phiwayinkosi V, Nyambuya Tawanda M, Johnson Rabia, Silvestri Sonia, Orlando Patrick, Mazibuko-Mbeje Sithandiwe E, Gabuza Kwazi B, Mxinwa Vuyolwethu, Mokgalaboni Kabelo, Tiano Luca, Muller Christo J F, Louw Johan, Nkambule Bongani B
Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, 7505, South Africa.
Department of Life and Environmental Sciences, Polytechnic University of Marche, 60131, Ancona, Italy.
Heart Fail Rev. 2021 Nov;26(6):1437-1445. doi: 10.1007/s10741-020-09942-y.
Metformin is considered a safe anti-hyperglycemic drug for patients with type 2 diabetes (T2D); however, information on its impact on heart failure-related outcomes remains inconclusive. The current systematic review explored evidence from randomized clinical trials (RCTs) reporting on the impact of metformin in modulating heart failure-related markers in patients with or without T2D. Electronic databases such as MEDLINE, Cochrane Library, and EMBASE were searched for eligible studies. Included studies were those assessing the use of metformin as an intervention, and also containing the comparison group on placebo, and all articles had to report on measurable heart failure-related indices in individuals with or without T2D. The modified Downs and Black checklist was used to evaluate the risk of bias. Overall, nine studies met the inclusion criteria, enrolling a total of 2486 patients. Although summarized evidence showed that metformin did not affect left ventricular function, this antidiabetic drug could improve myocardial oxygen consumption concomitant to reducing prominent markers of heart failure such as n-terminal pro-brain natriuretic peptide and low-density lipoprotein levels, inconsistently between diabetic and nondiabetic patients. Effective modulation of some heart failure-related outcomes with metformin treatment was related to its beneficial effects in ameliorating insulin resistance and blocking pro-inflammatory markers such as the aging-associated cytokine CCL11 (C-C motif chemokine ligand 11). Overall, although such beneficial effects were observed with metformin treatment, additional RCTs are necessary to improve our understanding on its modulatory effects on heart failure-related outcomes especially in diabetic patients.
二甲双胍被认为是2型糖尿病（T2D）患者安全的降糖药物；然而，关于其对心力衰竭相关结局影响的信息仍无定论。当前的系统评价探讨了随机临床试验（RCT）中有关二甲双胍对合并或不合并T2D患者心力衰竭相关标志物影响的证据。检索了MEDLINE、Cochrane图书馆和EMBASE等电子数据库以查找符合条件的研究。纳入的研究是那些评估二甲双胍作为干预措施的使用情况，且包含安慰剂对照组的研究，并且所有文章都必须报告合并或不合并T2D个体中可测量的心力衰竭相关指标。采用改良的唐斯和布莱克清单来评估偏倚风险。总体而言，9项研究符合纳入标准，共纳入2486例患者。尽管汇总证据表明二甲双胍不影响左心室功能，但这种抗糖尿病药物可改善心肌氧消耗，同时降低心力衰竭的显著标志物，如N末端脑钠肽前体和低密度脂蛋白水平，糖尿病患者和非糖尿病患者之间的情况不一致。二甲双胍治疗对某些心力衰竭相关结局的有效调节与其改善胰岛素抵抗和阻断促炎标志物（如衰老相关细胞因子CCL11（C-C基序趋化因子配体11））的有益作用有关。总体而言，尽管二甲双胍治疗观察到了这些有益效果，但仍需要更多的随机对照试验来加深我们对其对心力衰竭相关结局调节作用的理解，尤其是在糖尿病患者中。
