Metformin: effects on micro and macrovascular complications in type 2 diabetes

Cardiovasc Drugs Ther. 2008 Jun;22(3):215-24. doi: 10.1007/s10557-008-6092-0. Epub 2008 Feb 21.


Introduction: The antihyperglycaemic agent metformin is widely used in the treatment of type 2 diabetes. Data from the UK Prospective Diabetes Study and retrospective analyses of large healthcare databases concur that metformin reduces the incidence of myocardial infarction and increases survival in these patients. This apparently vasoprotective effect appears to be independent of the blood glucose-lowering efficacy.

Effects of metformin: Metformin has long been known to reduce the development of atherosclerotic lesions in animal models, and clinical studies have shown the drug to reduce surrogate measures such as carotid intima-media thickness. The anti-atherogenic effects of metformin include reductions in insulin resistance, hyperinsulinaemia and obesity. There may be modest favourable effects against dyslipidaemia, reductions in pro-inflammatory cytokines and monocyte adhesion molecules, and improved glycation status, benefiting endothelial function in the macro- and micro-vasculature. Additionally metformin exerts anti-thrombotic effects, contributing to overall reductions in athero-thrombotic risk in type 2 diabetic patients.

Publication types

  • Review

MeSH terms

  • Animals
  • Atherosclerosis / etiology
  • Atherosclerosis / prevention & control
  • Blood Glucose / metabolism
  • Blood Pressure / drug effects
  • Clinical Trials as Topic
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / metabolism
  • Diabetic Angiopathies / metabolism
  • Diabetic Angiopathies / prevention & control*
  • Endothelium, Vascular / drug effects
  • Fibrinolytic Agents / pharmacology
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / therapeutic use*
  • Lipids / blood
  • Metformin / adverse effects
  • Metformin / therapeutic use*
  • Oxidative Stress / drug effects
  • Treatment Outcome


  • Blood Glucose
  • Fibrinolytic Agents
  • Hypoglycemic Agents
  • Lipids
  • Metformin