A systematic review and meta-analysis of the protective effects of metformin in experimental myocardial infarction
| Autor: | Niels P. Riksen, Merel Ritskes-Hoitinga, Kimberley E. Wever, Saloua El Messaoudi, Michelle A. E. Brouwer, Bart Aalders, Nienke A. Hesen |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Critical Care and Emergency Medicine Swine Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] Myocardial Infarction lcsh:Medicine 030204 cardiovascular system & hematology Vascular Medicine law.invention Mice 0302 clinical medicine Mathematical and Statistical Techniques Endocrinology Randomized controlled trial law Ischemia Clinical endpoint Medicine and Health Sciences Myocardial infarction lcsh:Science Multidisciplinary Ejection fraction Vascular damage Radboud Institute for Molecular Life Sciences [Radboudumc 16] Heart Metformin Meta-analysis Physical Sciences Cardiology Rabbits Anatomy Statistics (Mathematics) medicine.drug Research Article Cardiac function curve medicine.medical_specialty Endocrine Disorders Cardiac Ventricles Cardiac Hypertrophy In Vitro Techniques Research and Analysis Methods 03 medical and health sciences Internal medicine Diabetes mellitus medicine Diabetes Mellitus Animals Statistical Methods business.industry lcsh:R Correction Biology and Life Sciences medicine.disease Rats Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10] 030104 developmental biology Metabolic Disorders Reperfusion Animal Studies Cardiovascular Anatomy lcsh:Q business Mathematics Meta-Analysis |
| Zdroj: | PLoS ONE PLoS One, 12 PLoS ONE, Vol 12, Iss 8, p e0183664 (2017) PLoS One, 12, 8 |
| ISSN: | 1932-6203 |
| Popis: | Contains fulltext : 177026.pdf (Publisher’s version ) (Open Access) Metformin improves cardiovascular prognosis in patients with diabetes mellitus, compared to alternative glucose-lowering drugs, despite similar glycemic control. Direct cardiovascular protective properties have therefore been proposed, and studied in preclinical models of myocardial infarction. We now aim to critically assess the quality and outcome of these studies. We present a systematic review, quality assessment and meta-analysis of the effect of metformin in animal studies of experimental myocardial infarction. Through a comprehensive search in Pubmed and EMBASE, we identified 27 studies, 11 reporting on ex vivo experiments and 18 reporting on in vivo experiments. The primary endpoint infarct size as percentage of area at risk was significantly reduced by metformin in vivo (MD -18.11[-24.09,-12.14]) and ex vivo (MD -18.70[-25.39, -12.02]). Metformin improved the secondary endpoints left ventricular ejection fraction (LVEF) and left ventricular end systolic diameter. A borderline significant effect on mortality was observed, and there was no overall effect on cardiac hypertrophy. Subgroup analyses could be performed for comorbidity and timing of treatment (infarct size and mortality) and species and duration of ischemia (LVEF), but none of these variables accounted for significant amounts of heterogeneity. Reporting of possible sources of bias was extremely poor, including randomization (reported in 63%), blinding (33%), and sample size calculation (0%). As a result, risk of bias (assessed using SYRCLE's risk of bias tool) was unclear in the vast majority of studies. We conclude that metformin limits infarct-size and improves cardiac function in animal models of myocardial infarction, but our confidence in the evidence is lowered by the unclear risk of bias and residual unexplained heterogeneity. We recommend an adequately powered, high quality confirmatory animal study to precede a randomized controlled trial of acute administration of metformin in patients undergoing reperfusion for acute myocardial infarction. |
| Databáze: | OpenAIRE |
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