Metformin didn’t considerably have an effect on the chance of cardiovascular outcomes in sufferers with coronary heart failure with lowered ejection fraction and diabetes or liable to diabetes. These have been the principle findings of the Met-HeFT trial and a meta-analysis offered in a Scorching Line session at present at ESC Congress 2026.
Metformin is essentially the most generally prescribed oral antidiabetic treatment worldwide. Kind 2 diabetes and coronary heart failure usually co-exist and plenty of sufferers with each situations are prescribed metformin. Nevertheless, as Principal Investigator of the Met-HeFT trial, Professor Henrik Wiggers from Aarhus College Hospital, Denmark, defined, there’s a lack of randomized trial proof on the usage of metformin in sufferers with coronary heart failure: “Observational research and small, short-term trials recommend that metformin could have cardioprotective results past glucose decreasing in sufferers with coronary heart failure however whether or not metformin improves cardiovascular outcomes has not been examined in a big long-term randomized trial,” he famous.
The investigator-initiated, double-blind Met-HeFT trial was carried out in 23 facilities in Denmark as a part of DANHEART. DANHEART had a factorial design, finding out metformin in sufferers with continual coronary heart failure and diabetes or prediabetes (Met-HeFT trial) and hydralazine–isosorbide dinitrate in sufferers with continual coronary heart failure (H-HeFT trial; additionally offered at ESC Congress 2026).
In Met-HeFT, eligible sufferers had symptomatic continual coronary heart failure, a left ventricular ejection fraction of as much as 40% and have been required to have kind 2 diabetes, prediabetes or be at elevated danger of creating kind 2 diabetes. A complete of 940 members have been randomised (1:1) to metformin or placebo. The imply age was 70 years and 16% have been ladies.
Over a imply follow-up of three.7 years, there was no important distinction between metformin and placebo for the first endpoint of dying, worsening coronary heart failure, acute myocardial infarction or stroke (25.1% vs. 23.4%; hazard ratio 1.10; 95% confidence interval 0.84 to 1.42; p=0.48).
Metformin remedy didn’t considerably have an effect on secondary endpoints corresponding to all-cause dying, unplanned coronary heart failure occasions, new-onset diabetes or change within the coronary heart pressure marker, NT-proBNP.
As a limitation of the trial, Professor Wiggers famous that solely round 10% of members had kind 2 diabetes. “Our lack of enrolment of patients with type 2 diabetes seemingly mirrored the prevailing widespread use of metformin and the reluctance of sufferers and clinicians to discontinue ongoing metformin remedy, which was a requirement for inclusion,” he stated. Nevertheless, he identified that lots of the sufferers had prediabetes and insulin resistance.
Additionally on the congress, Affiliate Professor Anders Hostrup Larsen from Goedstrup Hospital, Herning, Denmark, offered a meta-analysis of randomized placebo-controlled trials of metformin in sufferers with established coronary heart failure, which included information from Met-HeFT, and in sufferers with ischaemic coronary heart illness.2 Three coronary heart failure trials (involving 1,077 sufferers) and 4 ischaemic coronary heart illness trials (involving 1,123 sufferers) have been analyzed.
The meta-analysis got here to the identical conclusion because the Met-HeFT trial. There was no important distinction in cardiovascular outcomes with metformin in sufferers with coronary heart failure and a lowered ejection fraction and we additionally confirmed no important impact in established ischaemic coronary heart illness.”
Affiliate Professor Anders Hostrup Larsen, Goedstrup Hospital, Herning, Denmark
Summing up the proof, Professor Wiggers stated: “Metformin was not related to any hurt and it nonetheless stays helpful by way of glucose decreasing, however our analyses point out no important proof for any unbiased cardioprotective advantages.”
Supply:
