Aims
Metformin is the drug most often used to treat type 2 diabetes. Evidence suggests that metformin may reduce mortality of patients with type 2 diabetes, but the mechanism of such an effect is unknown and outcomes of metformin treatment in patients without diabetes have not been determined. If metformin favorably affected mortality of patients without diabetes, it might have even broader therapeutic utility. We evaluated the effect of metformin on myocardial energetics and ischaemic ventricular fibrillation (VF) in metabolically normal pigs.
Methods
Domestic farm pigs were treated with metformin (30 mg/kg/day orally for 2-3 weeks, n=36) or received no treatment (n=37). Under anaesthesia, pigs underwent up to 90 min low-flow regional myocardial ischaemia followed by 45 min reperfusion. Pigs were monitored for arrhythmia, monophasic action potential morphology, hemodynamics and myocardial substrate utilization, AMPK phosphorylation, citrate synthase activity, and ATP concentration.
Results
Death due to VF occurred in 12% of pigs treated with metformin, compared with 50% of untreated controls (p=0.03). The anti-fibrillatory effect of metformin was associated with attenuation of action potential shortening in ischaemic myocardium (p=0.02) and of the difference in action potential duration between ischaemic and non-ischaemic regions (p<0.001) compared with untreated controls. Metformin had no effect on myocardial contractile function, oxygen consumption, or glucose or lactate utilization. However, during ischaemia metformin treatment amplified the activation of AMPK, maintained citrate synthase activity, and preserved ATP concentration in myocardium, compared with untreated controls (each p<0.05).
Conclusions
Chronic treatment of metabolically normal pigs with metformin at a clinically relevant dose reduces mortality from ischaemic VF. This protection is associated with preservation of myocardial energetics during ischaemia. Maintenance of myocardial ATP concentration during ischaemia likely prevents action potential shortening, heterogeneity of repolarization, and propensity for lethal arrhythmia. The findings suggest that metformin might be protective in patients without diabetes with coronary heart disease.