A Randomized Controlled Trial of Metformin on Left Ventricular Hypertrophy in Patients With Coronary Artery Disease Without Diabetes - MET-REMODEL

Jan 24, 2020
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
British Heart Foundation
Date Published:
07/09/2019
Date Updated:
01/24/2020
Original Posted Date:
05/07/2019
References

Contribution To Literature:

The MET-REMODEL trial showed that metformin was effective at regressing LV hypertrophy. 

Description:

The goal of the trial was to evaluate metformin compared with placebo among patients with coronary artery disease/left ventricular (LV) hypertrophy/insulin resistance.

Study Design

  • Randomized
  • Parallel
  • Blinded
  • Placebo

Patients who met selection criteria were randomized to metformin XL 1000 mg twice daily versus placebo for 12 months. Subjects randomized to metformin started at a dose of 500 mg twice daily for 2 weeks.

  • Total number of enrollees: 68
  • Duration of follow-up: 12 months
  • Mean patient age: 65 years
  • Percentage female: 25%

Inclusion criteria:

Subjects 18-85 years of age with:

  • Coronary artery disease,
  • LV hypertrophy, and
  • Insulin resistance ± prediabetes

Exclusion criteria:

  • Diabetes
  • Uncontrolled hypertension

Principal Findings:

The primary outcome, change in LV mass indexed to height (LVMI), was -2.71 g/m in the metformin group compared with -1.34 g/m in the placebo group (p = 0.033).

Secondary outcomes:

  • Change in body weight: -3.6 kg in the metformin group compared with -0.01 kg in the placebo group (p = 0.001)
  • Change in systolic blood pressure: -4.8 mm Hg in the metformin group compared with 4.3 mm Hg in the placebo group (p = 0.022)

Interpretation:

Among patients with coronary artery disease/LV hypertrophy/insulin resistance, metformin versus placebo was effective at regressing LV hypertrophy. Metformin was also effective at weight loss and reduction in blood pressure. The VA IMPACT trial is currently evaluating metformin versus placebo among patients without diabetes and is powered for cardiovascular outcomes.

References:

Mohan M, Al-Talabany S, McKinnie A, et al. A randomized controlled trial of metformin on left ventricular hypertrophy in patients with coronary artery disease without diabetes: the MET-REMODEL trial. Eur Heart J 2019;40:3409-17.

Editorial: Rajagopalan S, Rashid I. Regression therapy for cardiovascular disease. Eur Heart J 2019;40:3418-20.

Clinical Topics: Cardiovascular Care Team, Prevention, Atherosclerotic Disease (CAD/PAD), Hypertension

Keywords: Blood Pressure, Blood Pressure Determination, Coronary Artery Disease, Diabetes Mellitus, Hypertension, Hypertrophy, Left Ventricular, Insulin Resistance, Metformin, Myocardial Ischemia, Prediabetic State, Secondary Prevention, Weight Loss


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