Metformin improves endothelial function in patients with metabolic syndrome
Abstract
Abstract.: Background. Metabolic Syndrome (MS) is associated with impaired endothelial function and increased cardiovascular risk. Insulin resistance is a key feature of MS and plays an important role in the pathogenesis of endothelial dysfunction. Aim of the present study was to evaluate the effect of metformin on endothelial function and insulin resistance, assessed by the homeostasis model (HOMA‐IR, homeostasis model assessment‐insulin resistance), in patients with MS. Methods. Sixty‐five subjects (37 men and 28 women, mean age 54 ± 6 years) with MS were allocated to receive metformin 500 mg twice daily (n = 32) or placebo (n = 33) for 3 months. Before and after treatment we assessed endothelial function, using flow‐mediated dilatation of the brachial artery, and HOMA‐IR. Results. Patients who received metformin demonstrated statistically significant improvement in endothelium‐dependent vasodilation compared with those treated with placebo (from 7.4 ± 2.1% to 12.4 ± 1.9% vs. 7.3 ± 2.5% to 6.9 ± 2.7%, P = 0.0016, metformin vs. placebo respectively), without significant effect on endothelium‐independent response to sublingual glyceryl trinitrate (P =0.32). Metformin improved insulin resistance compared with placebo group (HOMA‐IR from 3.39 to 2.5 vs. 3.42 to 3.37; 26% reduction in HOMA‐IR, P = 0.01). An association between the improvement in insulin resistance and the improvement in endothelial function (r = −0.58, P = 0.0016) was found. Conclusion. Metformin improves both endothelial function and insulin resistance in patients with MS. These findings support the central role of insulin resistance in the development of endothelial dysfunction and the role of metformin for the treatment of patients with MS.
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Metformin significantly improves endothelium-dependent flow without a significant effect on endothelium-independent response.
“Conversely, Vitale et al. found significant improvement of endothelium dependent flow without a significant effect on endothelium independent response [90].”
From Metformin: An Old But Still the Best Treatment for Type 2 Diabetes (2013) · cites this paper as [90]
Many different mechanisms beyond glycemic control have been implicated in vascular protection induced by metformin, including improvements in the inflammatory pathway, coagulation, oxidative stress and glycation, endothelial dysfunction, haemostasis, insulin resistance, lipid profiles, and fat redistribution.
“Many different mechanisms, beyond glycemic control, have been implicated in vascular protection induced by metformin such as improvements in the inflammatory pathway [86], coagulation [87], oxidative stress and glycation [88-92], endothelial dysfunction [88-90], haemostasis [88,91-93], insulin resistance improvement [94], lipid profiles [95,96], and fat redistribution [97,98].”
From Metformin: An Old But Still the Best Treatment for Type 2 Diabetes (2013) · cites this paper as [90]
Metformin improves endothelial function in patients with metabolic syndrome.
“but metformin improves endothelial function in patients with metabolic syndrome and improvement in FMD correlates with improvement in insulin resistance.199”
From The Vasculature in Prediabetes (2018) · cites this paper as [199]
Improvement in FMD correlates with improvement in insulin resistance in patients with metabolic syndrome treated with metformin.
“but metformin improves endothelial function in patients with metabolic syndrome and improvement in FMD correlates with improvement in insulin resistance.199”
From The Vasculature in Prediabetes (2018) · cites this paper as [199]
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- Authors
- VITALE, C., MERCURO, G., CORNOLDI, A., FINI, M., VOLTERRANI, M., & ROSANO, G. M. C.
- Affiliations
- Istituti di Ricovero e Cura a Carattere Scientifico (IT)
- University of Cagliari (IT)
- Corresponding author
- ROSANO, G. M. C.
- Venue
- Journal of Internal Medicine
- Publisher
- Wiley
- Published
- 2005-08-19
- Volume
- 258
- Issue
- 3
- Pages
- 250-256
- ISSN
- 0954-6820 (ISSN-L)
- 1365-2796
- OpenAlex
- W2099868021
- Cited by
- 164
- References
- 44
- Citations by year
- 2025: 4 · 2024: 6 · 2023: 6 · 2022: 6 · 2021: 7 · 2020: 7 · 2019: 10 · 2018: 5 · 2017: 9 · 2016: 7 · 2015: 12 · 2014: 13 · 2013: 10 · 2012: 7
- FWCI
- 6.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
- Keywords
- metformin, metabolic syndrome, endothelial function, insulin resistance, endothelial dysfunction, flow-mediated dilation, HOMA-IR, nitroglycerin, cardiovascular risk
- MeSH terms
- Brachial Artery, Endothelium, Vascular, Female, Nitroglycerin, Homeostasis, Humans, Hypoglycemic Agents, Image Processing, Computer-Assisted, Insulin Resistance, Male, Metformin, Middle Aged, Ultrasonography, Vasodilator Agents, Multivariate Analysis, Metabolic Syndrome
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