Oleh Admin Kalbe Medical pada July 13, 2017 07:30

Metformin dapat Menurunkan Penyakit Kardiovaskuler pada Pasien Prediabetes, Benarkah?

Prevalensi dan tingkat keparahan dari coronary artery calcium (CAC) mengalami penurunan yang signifikan pada laki-laki dibandingkan wanita, setelah terapi metformin, pada pasien pre-diabetes selama 14 tahun. Hasil tersebut didapatkan berdasakan studi kohort longitudinal. Temuan tersebut berdasarkan pengukuran CAC serial terhadap >2000 orang yang terlibat dalam Diabetes Prevention Program (DPP) dan DPP Outcomes Study (DPPOS). Studi kohort longitudinal tersebut merupakan studi yang pertama kali dilakukan untuk menilai metformin dalam efek perlindungannya terhadap munculnya penyakit jantung pada pasien non-diabetes (pre-diabetes). Efek tersebut tetap muncul walaupun cukup banyak individu dalam studi yang juga mengonsumsi obat antihipertensi dan statin. Sepertinya metformin berpengaruh terhadap lesi aterosklerosis yang paling kecil, namun lesi tersebut berimplikasi terhadap terjadinya aterosklerosis awal.    

Studi DPP tersebut telah dipublikasikan sekitar 15 tahun yang lalu, menelusuri 3234 individu dengan pre-diabetes dan melihat penurunan pada insidens diabetes baru sekitar 31% pada mereka dengan metformin saja dan 58% pada mereka yang hanya dengan intervensi gaya hidup. Sebelumnya sekitar 2776 partisipan DPP ini diikuti karena aterosklerosis subklinis yang dideritanya, kemudian ikut dalam DDPOS dengan melanjutkan sesi intervensi gaya hidup, di mana pasien yang sebelumnya sudah diberikan metformin tetap dilanjutkan pemberiannya jika pasien tersebut masih eligible.

Penilaian dilakukan terhadap variabel klinis dan metabolik pada kondisi basal dan di setiap tahunnya. Sedangkan scan atau pemindaian kalsium di pembuluh koroner diambil pada tahun ke-10 dari studi DDPOS terhadap 2029 partisipan, yang mewakili 74% dari kohort. Rerata durasi terapi metformin adalah 9,6 tahun,1,7 tahun, dan 1,3 tahun pada kelompok serta intervensi gaya hidup. Diabetes kemudian muncul pada 54%, 59%, dan 51% pasien, secara berturut-turut. Peneliti menemukan bahwa tidak ada perbedaan yang signifikan pada kelompok gaya hidup dan plasebo dalam hal tingkat keparahan dan adanya CAC baik pada wanita maupun pria. Namun, tingkat keparahan CAC lebih kecil secara signifikan pada pria dibandingkan wanita bagi mereka yang diberikan metformin vs plasebo.

Simpulan:
Tampaknya metformin berpengaruh terhadap lesi aterosklerosis yang paling kecil, yang justru berimplikasi terhadap proses aterosklerosis awal. Jika memiliki efek perlindungan berarti memerlukan penggunaan meftormin jangka panjang. Studi ini sebaiknya dapat dikonfirmasi dengan studi klinik untuk membuktikan bahwa metformin dapat menurunkan penyakit kardiovaskuler. (PMD)

Image : Ilustrasi
Referensi:
Davenport L. Long-term metformin may reduce coronary calcium [Internet]. 2017 [cited 2017 June 2]. Available from: http://www.medscape.com/viewarticle/880754.

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