Metformin heart rate
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The Impact of Metformin on Heart Rate and Cardiovascular Health
Metformin and Heart Rate Variability in Type 1 Diabetes
Metformin, a common medication for diabetes, has shown potential benefits beyond glucose control, particularly in cardiovascular health. A study focusing on adolescents with Type 1 Diabetes (T1D) revealed that metformin significantly improved heart rate variability (HRV), a key indicator of cardiac autonomic function. The study found that metformin, when added to insulin therapy, increased several HRV parameters such as SDNN, SDANN, pNN50, and HF power, indicating enhanced cardiac autonomic regulation 1. These improvements were independent of changes in metabolic parameters like HbA1c, BMI, and lipid profiles, suggesting a direct cardiovascular benefit of metformin in this population 1.
Metformin and Orthostatic Blood Pressure in Type 2 Diabetes
In contrast, another study highlighted a potential adverse effect of metformin on cardiovascular autonomic function in patients with Type 2 Diabetes (T2D). The research indicated that metformin might impair orthostatic blood pressure recovery, evidenced by an increased early drop in systolic and diastolic blood pressure upon standing. This suggests that while metformin has several benefits, it may also pose risks for certain cardiovascular functions in T2D patients 2.
Metformin and Exercise-Induced Heart Rate Changes
Metformin's interaction with exercise also affects heart rate. A study examining the combined effects of metformin and exercise in T2D patients found that metformin increased heart rate and plasma lactate levels during submaximal exercise. This interaction suggests that metformin could necessitate adjustments in exercise prescriptions for patients to avoid excessive cardiovascular strain 3.
Cardioprotective Effects of Metformin
Beyond its effects on heart rate, metformin has been associated with broader cardioprotective benefits. Several studies have shown that metformin reduces the risk of cardiovascular events and mortality in patients with coronary artery disease (CAD) and heart failure (HF). These benefits are thought to be mediated through mechanisms such as increased AMPK phosphorylation and enhanced nitric oxide production, which improve endothelial function and myocardial remodeling 456.
Metformin in Non-Diabetic Cardiovascular Health
Interestingly, metformin's cardiovascular benefits extend to non-diabetic populations as well. Research on non-diabetic rats with post-myocardial infarction (MI) heart failure demonstrated that metformin improved cardiac function and reduced infarct size, suggesting its potential utility in managing heart failure independent of its glucose-lowering effects 8. Additionally, metformin has been shown to reduce left ventricular hypertrophy (LVH) in patients with CAD and pre-diabetes, further supporting its role in cardiovascular health 6.
Conclusion
Metformin's impact on heart rate and cardiovascular health is multifaceted. While it improves heart rate variability and offers significant cardioprotective benefits, it may also adversely affect orthostatic blood pressure recovery and increase heart rate during exercise. These findings underscore the importance of personalized medical approaches when prescribing metformin, considering both its benefits and potential risks for cardiovascular health.
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Most relevant research papers on this topic
546-P: Effects of Metformin on Heart Rate Variability in Adolescents with Type 1 Diabetes: A Secondary Analysis of a Randomized Crossover-Controlled Trial
Metformin increased heart rate variability in adolescents with Type 1 diabetes, but had no obvious effect on improving metabolic parameters.
RCT
Very Rigorous JournalMetformin may adversely affect orthostatic blood pressure recovery in patients with type 2 diabetes: substudy from the placebo-controlled Copenhagen Insulin and Metformin Therapy (CIMT) trial
Metformin combined with insulin may increase early drop in orthostatic blood pressure, potentially worsening cardiovascular autonomic neuropathy in type 2 diabetes patients.
RCT
Large Human TrialVery Rigorous JournalMetformin and Exercise in Type 2 Diabetes
Metformin increases heart rate during exercise and may lead to lower exercise workloads, while exercise interferes with metformin's glucose-lowering effect.
RCT
Rigorous Journal
Highly CitedCardioprotection by Metformin: Beneficial Effects Beyond Glucose Reduction
Metformin has cardioprotective properties beyond glucose reduction, potentially improving heart health and reducing the risk of reinfarction and all-cause mortality in patients with coronary artery disease and congestive heart failure.
Meta-AnalysisVery Rigorous JournalEffect of metformin on all-cause and cardiovascular mortality in patients with coronary artery diseases: a systematic review and an updated meta-analysis
Metformin reduces cardiovascular mortality, all-cause mortality, and cardiovascular events in coronary artery disease patients, with a better effect than sulfonylureas.
Meta-AnalysisVery Rigorous JournalHighly CitedA randomized controlled trial of metformin on left ventricular hypertrophy in patients with coronary artery disease without diabetes: the MET-REMODEL trial
Metformin treatment significantly reduced left ventricular hypertrophy, body weight, and oxidative stress in patients with coronary artery disease without diabetes.
RCTRigorous JournalHighly CitedImpact of metformin on cardiovascular disease: a meta-analysis of randomised trials among people with type 2 diabetes
Metformin shows mixed results in reducing cardiovascular disease risk in patients with type 2 diabetes, but a definitive placebo-controlled trial is needed to confirm its effectiveness.
Meta-AnalysisRigorous JournalHighly CitedMetformin improves cardiac function in a nondiabetic rat model of post-MI heart failure.
Metformin may have potential to reduce heart failure development after a myocardial infarction, even in the absence of diabetes and independent of systemic glucose levels.
RCT
Animal StudyHighly CitedCardiovascular and metabolic effects of metformin in patients with type 1 diabetes (REMOVAL): a double-blind, randomised, placebo-controlled trial.
Metformin treatment may reduce atherosclerosis progression in adults with type 1 diabetes at increased risk for cardiovascular disease, but its long-term cardiovascular benefits remain unclear.
RCTLarge Human TrialHighly CitedCardioprotective effect of metformin in lipopolysaccharide-induced sepsis via suppression of toll-like receptor 4 (TLR4) in heart.
Metformin exhibits cardioprotective effects in sepsis by suppressing TLR4 activity in the heart, partially through AMPK activation.
RCTAnimal Study