Researchers report that treatment with metformin appears to reduce mortality rates in patients with heart failure (HF) and diabetes.

David Aguilar (Baylor College of Medicine, Houston, Texas, USA) and colleagues explain that although diabetes and HF commonly co-exist, optimal treatment for such patients has not been studied in detail.

To investigate the possible benefits of metformin for these patients, Aguilar and team studied mortality rates over 2 years of follow-up in 6185 patients with HF and diabetes, of whom 1561 were treated with metformin and 4624 were not.

All the patients were taking a combination of other drugs including: insulin, sulfonylureas, thiazolidinediones, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, spironolactone, beta blockers, and statins.

As reported in the journal Circulation: Heart Failure, 246 (15.8%) patients taking metformin and 1177 (25.5%) of those who were not taking the medication died during follow-up, a statistically significant between-group difference.

The researchers carried out a propensity-score (probability of being treated given the covariates) matched analysis. This showed that death occurred within 2 years in 232 (16.1%) and 285 (19.8%) patients in the metformin and no metformin groups, respectively, corresponding to a significant 24% reduction in the relative risk for death with metformin.

Of note, the investigators found no significant differences in hospitalization for HF or total hospitalization rates between the two groups.

“Given the current burden and expected growth in the number of patients with diabetes and HF, it is critically important that future studies assess the optimal treatment strategy for glycemic control in this population,” say Aguilar and co-authors.

“Addressing these issues will require carefully designed prospective observational studies to confirm safety and randomized controlled clinical trials to assess efficacy,” they conclude.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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Australian researchers suggest that a maternal family history of diabetes may reduce the risk for cardiovascular disease (CVD) in female, but not male, patients with diabetes.

David Bruce, from the University of Western Australia in Nedlands, and colleagues say that although they are unsure of the cause of the differential effect of maternal family history of diabetes in males and females, “gender differences resulting from genetic and epigenetic transmission in a range of common complex disorders, including CVD and Type 2 diabetes,” may be involved.

The researchers investigated the family histories of 1294 diabetic patients (663 women and 631 men) aged an average of 64.1 years, recruited from 1993 to 1996.

All-cause mortality, cardiac mortality, and myocardial infarction (MI) rates were monitored from recruitment until 2006.

In all, 20.4%, 8.3%, and 2.0% of the patients reported a maternal, paternal or bi-parental family history of diabetes.

Patients with a maternal history of diabetes had poorer glycemic control than those with a paternal history of diabetes, as reflected by significantly higher fasting serum glucose and percentage glycosylated hemoglobin levels, at 8.9 mmol/l versus 8.4 mmol/l and 7.9% versus 7.2% respectively.

As reported in the journal Diabetes Care, 493 patients died during the follow-up period - 197 died from cardiac causes, 278 had a MI, and 132 had a stroke.

Unadjusted all-cause mortality rates were significantly lower in patients with a maternal (29.5%) or paternal (34.0%) history of diabetes compared with those with no parental history of diabetes (41.9%).

All patients with a maternal history of diabetes had a reduced rate of all-cause and cardiac mortality compared with those with no parental diabetic history, at 29.5% versus 41.9%, and 8.7% versus 17.9%, respectively.

When analyzed by gender, female patients with a maternal diabetic history had a reduced risk for all-cause and cardiac mortality compared with patients with no parental history of diabetes, with a 37% and 68% risk reduction respectively.

The risk for a first MI was also significantly reduced by 55% among female patients with a maternal history of diabetes, compared with all patients with no parental history of diabetes.

However, this trend did not extend to male patients with a maternal history of diabetes. These individuals had a similar risk for all-cause and cardiac mortality, and first MI as male patients without a parental history of diabetes.

The researchers conclude: “These data indicate another source of heterogeneity in the clinical impact of Type 2 diabetes and have relevance for understanding the pathophysiology, epidemiology, and public health impact of cardiovascular disease in women with Type 2 diabetes.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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