Metformin was also associated with a lower risk for heart failure readmission in patients with heart failure and kidney disease, but it did not confer a lower risk for major cardiovascular events in those patients.
A related editorial discusses the findings of this meta-analysis, highlighting that the US FDA decision to eliminate the heart failure warning in response to two large observational studies that suggested that metformin is safe and may be beneficial in patients with compensated heart failure, and the safety communication relaxing the renal contraindications are appropriate.
The systematic review published above has been used to issue updated American College of Physicians guidance on the oral pharmacological management of type 2 diabetes mellitus.
The European Medicines Agency had also issued a statement advising that current scientific evidence does not justify contraindication in patients with moderate reduction of renal function.