Dihoum Adel, Rena Graham, Pearson Ewan R, Lang Chim C, Mordi Ify R
Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK.
Division of Cellular Medicine, University of Dundee, Dundee, UK.
Expert Opin Investig Drugs. 2023 Apr;32(4):291-299. doi: 10.1080/13543784.2023.2196010. Epub 2023 Apr 3.
For a long time, metformin has been the first-line treatment for glycemic control in type 2 diabetes; however, the results of recent cardiovascular outcome trials of sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide 1 receptor agonists have caused many to question metformin's position in the guidelines. Although there are several plausible mechanisms by which metformin might have beneficial cardiovascular effects, for example, its anti-inflammatory effects and metabolic properties, and numerous observational data suggesting improved cardiovascular outcomes with metformin use, the main randomized clinical trial data for metformin was published over 20 years ago. Nevertheless, the overwhelming majority of participants in contemporary type 2 diabetes trials were prescribed metformin.
In this review, we will summarize the potential mechanisms of cardiovascular benefit with metformin, before discussing clinical data in individuals with or without diabetes.
Metformin may have some cardiovascular benefit in patients with and without diabetes, however the majority of clinical trials were small and are before the use SGLT2 inhibitors and GLP1-RAs. Larger contemporary randomized trials, with metformin evaluating its cardiovascular benefit are warranted.
长期以来，二甲双胍一直是2型糖尿病血糖控制的一线治疗药物；然而，近期钠-葡萄糖协同转运蛋白2抑制剂和胰高血糖素样肽1受体激动剂的心血管结局试验结果让许多人对二甲双胍在指南中的地位产生质疑。尽管二甲双胍可能通过多种合理机制产生有益的心血管效应，例如其抗炎作用和代谢特性，并且大量观察数据表明使用二甲双胍可改善心血管结局，但二甲双胍的主要随机临床试验数据是20多年前发表的。尽管如此，当代2型糖尿病试验的绝大多数参与者都被处方使用二甲双胍。
在本综述中，我们将在讨论糖尿病患者和非糖尿病患者的临床数据之前，总结二甲双胍心血管获益的潜在机制。
二甲双胍可能对糖尿病患者和非糖尿病患者都有一定的心血管益处，然而大多数临床试验规模较小，且是在使用钠-葡萄糖协同转运蛋白2抑制剂和胰高血糖素样肽1受体激动剂之前进行的。有必要开展更大规模的当代随机试验，以评估二甲双胍的心血管益处。
