Letter by Mordi et al Regarding Article, "Metformin Use and Clinical Outcomes Among Patients With Diabetes Mellitus With or Without Heart Failure or Kidney Dysfunction: Observations From the SAVOR-TIMI 53 Trial".
Abstract
January 28, 2020 e55 Ify R. Mordi, MD Mohapradeep Mohan, PhD Chim C. Lang, MD To the Editor: We read with great interest the analysis of the SAVOR-TIMI 53 trial (Saxagliptin and Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus) examining metformin use and clinical outcomes by Bergmark et al.1 The authors’ finding that metformin use was associated with a reduction in all-cause mortality and cardiovascular death but not myocardial infarction or stroke, particularly in patients without a history of heart failure, is particularly intriguing, especially in the light of recent outcome trials of SGLT2 inhibitors and glucagon-like peptide 1 agonists demonstrating cardiovascular benefit, leading some to question the place of metformin as first-line type 2 diabetes mellitus therapy. This study adds to the increasing support for and interest in the cardiovascular benefits of metformin.2 One key question generated by this study is by what pathway metformin might exert any beneficial cardiovascular effects. Although metformin is associated with modest reductions in blood pressure and weight, and has reported antiatherosclerotic effects, these are unlikely to be the primary mechanisms, given that there was no reduction in myocardial infarction or stroke. Prevention of adverse remodeling, in particular left ventricular hypertrophy caused by metformin, might be the key pathophysiologic mechanism by which it exerts its cardiovascular outcome benefit, perhaps driven by its…
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