Metformin to prevent heart disease?

My GP ('general' doctor - not sure what you call them in the States) has told me to take Metformin as part of my new regime to stop my CAD turning into worse heart problems.

I used to be diagnosed as a diabetic, but was 'signed-off' by the diabetologists a couple of years ago. They re-labelled me as 'glucose intolerant', said they'd keep an eye on me in future, and told me to stop my diabetic medication (metformin and gliclazide).

My GP obviously knows these facts, yet he insists that metformin has other properties in addition to combating too-high blood sugar levels. He says that a) it is an appetite suppressant, and will thus help weight loss (I've never seen any sign of my appetite being suppressed while taking it!) and b) that it 'protects the heart'.

I wonder if any other contributors have been advised to take metformin, even if they're not diabetic. And what is US medical thinking on the subject?

Best regards,

Allen-UK, London.

Hello Erskine, and thank you.

I am seeing a consultant cardiologist in a couple of weeks for an initial assessment, so I will add the question to those I intend to ask him.

My GP is a smashing guy, and tends to under- rather than over-prescribe, which I appreciate. He does, however, think most of the 'number' indicators should be on the low side, i.e. 120/70 could be better, 6.0 blood glucose level could be 5.0, 'bad' cholesterol score could be even lower, and so on. I understand his point of view, but I just want to avoid unnecessary medications.

Allen-UK, London.

Aldo,

Metformin does decrease the incidence of developing diabetes, but there are inherent risks in taking the medication--I do not know Allen's creatinine, or his liver status. Both of those could be contraindications to taking metformin. In addition there is the cost associated with metformin. At this time, I do not recommend my glucose-intolerant patients who have heart disease to take an additional pill--they are already usually on an aspirin (and sometimes plavix <clopidogrel>), an ace-i or ARB, a beta-blocker, and a statin. And that is if they do not have hypertension--if they have hypertension, they are usually on even more medications--so I usually do not recommend my patients taking another pill on top of all the others, if they are "just" glucose-intolerant.

That being said, I am NOT Allen's physician, and I will defer to his physicians completely, as they are taking care of him--and know his situation better than I do. In addition, they may have knowledge of trials that have not been published that they are involved in that may show benefits of a medication. So, again, I am not trying to argue with Allen's physicians--just trying to show a point of view.