The effect of metformin on cardiovascular risk profile in patients without diabetes presenting with acute myocardial infarction: data from the Glycometabolic Intervention as adjunct to Primary Coronary Intervention in ST Elevation Myocardial Infarction (GIPS-III) trial

摘要

Objective In patients with diabetes mellitus, metformin treatment is associated with reduced mortality and attenuation of cardiovascular risk. As a subanalysis of the Glycometabolic Intervention as adjunct to Primary Coronary Intervention in ST Elevation Myocardial Infarction (GIPS-III) study, we evaluated whether metformin treatment in patients with ST-segment elevation myocardial infarction (STEMI) without diabetes improves the cardiovascular risk profile. Methods A total of 379 patients, without known diabetes, presenting with STEMI were randomly allocated to receive metformin 500?mg twice daily or placebo for 4?months. Results After 4?months, the cardiovascular risk profile of patients receiving metformin (n=172) was improved compared with placebo (n=174); glycated hemoglobin (5.83% (95% CI 5.79% to 5.87%) vs 5.89% (95% CI 5.85% to 5.92%); 40.2?mmol/mol (95% CI 39.8 to 40.6) vs 40.9?mmol/mol (40.4 to 41.2), p=0.049); total cholesterol (3.85?mmol/L (95% CI 3.73 to 3.97) vs 4.02?mmol/L (95% CI 3.90 to 4.14), p=0.045); low-density lipoprotein cholesterol (2.10?mmol/L (95% CI 1.99 to 2.20) vs 2.3?mmol/L (95% CI 2.20 to 2.40), p=0.007); body weight (83.8?kg (95% CI 83.0 to 84.7) vs 85.2?kg (95% CI 84.4 to 86.1), p=0.024); body mass index (26.8?kg/m2 (95% CI 26.5 to 27.0) vs 27.2?kg/m2 (95% CI 27.0 to 27.5), p=0.014). Levels of fasting glucose, postchallenge glucose, insulin, high-density lipoprotein cholesterol, and blood pressure were similar in both groups. Conclusions Among patients with STEMI without diabetes, treatment with metformin for 4?months resulted in a modest improvement of the cardiovascular risk profile compared with placebo. Trial register number NCT01217307.