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Heart failure (HF) is a major public health problem in the United States. Heart failure itself leads to insulin resistance and the role of medication that has effect on insulin resistance has not been well studied. We hypothesized metformin, an insulin sensitizer, may delay the progression of heart failure in high-risk group (ACC Stage A and Stage B).
This is a retrospective observational study between 2005–2011. We included 300 consecutive patients with Left Ventricular Hypertrophy (LVH) based on Echocardiogram during the calendar year 2005. 212 patients met exclusion criteria, which include established heart failure, end stage renal disease, patients on palliative care and patients without follow-up data. Study patients were divided into three different arms, which included Non-diabetic patients with LVH and other risk factors, Diabetic patients with LVH who are not on metformin and Diabetic patients with LVH who are on metformin. Follow-up included review of case records from 2005 to 2011. Primary endpoint was development of heart failure (ACC Stage C) during the study period.
There was significant different in development of heart failure in diabetic metformin treated group, compared to non-diabetic group and diabetic non-metformin group (0%, 28% and 52%). Within diabetic group, there is significant reduction in incidence of heart failure in metformin group compared to non-metformin group (Risk reduction 54% and p = 0.001). In patients with LVH, ejection fraction (EF) or change in EF is not the predictor for Heart Failure development. They are high risk for Heart Failure with Preserved EF. Metformin group did not develop any symptoms of HF.
Metformin may delay the progression of early stages (ACC stage A and stage B) of heart failure to advanced stage (Stage C). Further more evidence and a randomized control trial may be needed to validate this findings.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Heart Failure: Pharmacologic Therapy
Abstract Category: 17. Heart Failure: Therapy
Presentation Number: 1223-305
- 2013 American College of Cardiology Foundation