Metformin Therapy and Outcomes in Patients With Advanced Systolic Heart Failure and Diabetes
Received 6 May 2009; received in revised form 7 October 2009; accepted 15 October 2009. published online 16 November 2009.
Abstract
Background
Although 25% to 44% of patients with heart failure (HF) have diabetes mellitus (DM), the optimal treatment regimen for HF patients with DM is uncertain. We investigated the association between metformin therapy and outcomes in a cohort of advanced, systolic HF patients with DM.
Methods and Results
Patients with DM and advanced, systolic HF (n = 401) were followed at a single university HF center between 1994 and 2008. The cohort was divided into 2 groups based on the presence or absence of metformin therapy. The cohort had a mean age of 56 ± 11 years, left ventricular ejection fraction (LVEF) of 24 ± 7%, with 42% being New York Heart Association (NYHA) III and 45% NYHA IV. Twenty-five percent (n = 99) were treated with metformin therapy. The groups treated and not treated with metformin were similar in terms of age, sex, baseline LVEF, medical history, and baseline glycosylated hemoglobin. Metformin-treated patients had a higher body mass index, lower creatinine, and were less often on insulin. One-year survival in metformin-treated and non-metformin-treated patients was 91% and 76%, respectively (RR = 0.37, CI 0.18-0.76, P = .007). After multivariate adjustment for demographics, cardiac function, renal function, and HF medications, metformin therapy was associated with a nonsignificant trend for improved survival.
Conclusion
In patients with DM and advanced, systolic HF who are closely monitored, metformin therapy appears to be safe. Prospective studies are needed to determine whether metformin can improve HF outcome.
2David Geffen School of Medicine, University of California, Los Angeles, CA
Reprint requests: Tamara B. Horwich, MD, MS, Ahmanson-UCLA Cardiomyopathy Center, UCLA Division of Cardiology, 10833 Le Conte Ave. CHS A2-237, Los Angeles, CA 90095. Tel: (310) 825-8816; Fax: (310) 206-9133.
Dr. Horwich was supported by NIH/NHLBI1K23HL085097. Dr. Fonarow was supported by the Ahmanson Foundation (Los Angeles, CA) and holds the Eliot Corday Chair in Cardiovascular Medicine and Science.
ABSTRACT