Metformin Cardiovascular Evidence — EECC MCQ
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Correct answer: D — The UKPDS showed metformin reduced MI and all-cause mortality in overweight T2DM patients; it remains first-line for T2DM, though newer agents (SGLT2i, GLP-1 RA) now have stronger contemporary CV endpoint trial evidence
The UKPDS (1998) demonstrated that metformin reduced MI by 39% and all-cause mortality by 36% in overweight patients with newly diagnosed T2DM, compared with conventional treatment. This established metformin as the first-line glucose-lowering agent for T2DM. However, the UKPDS was conducted before the era of modern CV outcome trials and the evidence quality is lower than contemporary trials. SGLT2 inhibitors (EMPA-REG, DECLARE, DAPA-CKD) and GLP-1 receptor agonists (LEADER, SUSTAIN-6, REWIND) now have stronger RCT evidence for MACE reduction in T2DM with established CVD or high CV risk. Current guidelines (ESC/EASD) recommend: metformin as first-line for all T2DM, with SGLT2i and/or GLP-1 RA added early (even before metformin uptitration) in patients with established ASCVD, HF, or CKD.
Reference: ESC/EASD Diabetes Guidelines; UKPDS