As outlined by the authors, use of metformin is an appealing option because it is safe, produces few side effects, and is a cost-effective way to target some of the defects known to contribute to the metabolic defects associated with diabetes.
In the cohort study conducted by Ahmed and colleagues, the investigators assessed whether diabetes was associated with worse outcomes in heart failure regardless of the associated risk factors and comorbidities.
We recruited 973 patients (mean age, 81 years) with atrial fibrillation from the primary care setting and randomly assigned them to receive anticoagulation with warfarin or aspirin.
The article by Mant and colleagues concerning the Birmingham Atrial Fibrillation Treatment of the Aged (BAFTA) study is a welcomed addition to the now vast literature regarding the relative benefits of warfarin anticoagulation in patients with atrial fibrillation.
We conducted a study to determine whether high lipoprotein(a) levels predicted the risk of myocardial infarction (MI) and ischemic heart disease. Unlike other studies, we measured lipoprotein(a) levels shortly after sampling and corrected for regression dilution bias.
This propensity-matched study, in which patients with and without diabetes were well balanced in all measured baseline characteristics, including traditional risk factors and comorbidities, found that diabetes was associated with increased mortality and hospitalization in ambulatory patients who had chronic, mild-to-moderate heart failure and were receiving angiotensin-converting enzyme inhibitors. These findings also highlight the sex- and age-related variations in the effect of diabetes in these patients.
A recent meta-analysis of 31 randomized controlled trials with 4500 participants showed that metformin treatment significantly decreased weight, improved dyslipidemia and insulin resistance, and reduced the incidence of new-onset diabetes by 40%, with beneficial effects maintained over time. Further studies will show whether the metabolic improvements achieved with metformin treatment will ultimately result in a decrease in cardiovascular morbidity and mortality.