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A CV benefit of metformin not found in people without diabetes

Metformin is our standard first-line agent in type 2 diabetes in part because of the positive cardiovascular outcomes that were demonstrated in a small cohort of patients in the UKPDS. It had been thought that this effect might have been independent of improvements in glycaemic control. Unfortunately, in the recent Scottish CAMERA study, metformin did not appear to have any cardiovascular benefits in people without diabetes who had established heart disease.

by Colin Kenny, GP, Dromore

The CAMERA (Carotid Atherosclerosis: Metformin for Insulin Resistance) study was a double-blind, placebo-controlled trial was conducted in a single centre in Scotland. Participants (n=173; mean age, 63 years) did not have diabetes, but they had established coronary heart disease and a large waist circumference and they were taking statin therapy. Individuals were randomised to metformin 850 mg twice daily or placebo.

Following 18 months of treatment there was no difference between the groups in change to carotid plaque score, which is a surrogate marker for ischaemic heart disease. Lipid profiles and fasting blood glucose levels did not differ either. Adverse events generally occurred at similar rates in the groups, although cases of diarrhoea, nausea or vomiting were more common in the metformin group.

The rate of combined cardiovascular disease events – myocardial infarction, stroke, coronary revascularisation, unstable angina or cardiovascular death – was 5% with metformin and 7% with placebo; only 10 participants had one of those events during the study.

The research team concluded that metformin had no effect on several surrogate markers of cardiovascular disease in people without diabetes who had a high cardiovascular risk and were taking statins, and they suggested that further evidence is needed before metformin can be recommended for cardiovascular benefit in a population as investigated.

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