Preliminary results presented at the American Heart Association (AHA) Scientific Sessions 2024 found that treatment with metformin, a common type 2 diabetes medication, lifestyle changes, or a combination of the two did not significantly reduce atrial fibrillation (AFib) or progression from standard care.1
Metformin and lifestyle changes show no significant impact on atrial fibrillation (AFib) burden or progression compared to standard care. | Image credit: ibreakstock – stock.adobe.com
“Interventions including weight loss, exercise and metformin act on an enzyme called AMP kinase, which is the main regulator of metabolic stress in cells,” said lead study author Mina K. Chung. , MD, FAHA, cardiologist and professor of medicine at the Cleveland Clinic in Ohio, in a statement. “In this study, we examined whether interventions including these could reduce the burden or progression of atrial fibrillation. »
Metformin works by reducing glucose production in the liver, helping to effectively regulate blood sugar levels. Atrial fibrillation, the most common type of arrhythmia, poses significant health risks, including stroke, heart failure, and other cardiovascular complications. More than 12 million people in the United States are expected to live with atrial fibrillation by 2030, highlighting the urgent need for effective prevention strategies, according to the AHA’s 2024 Heart Disease and Stroke Statistics. and management.
The TRIM-AF (NCT03603912) included 149 adults with atrial fibrillation, who were randomly assigned to 1 of 4 treatment groups: standard care (educational leaflets on diet and exercise without personalized counseling), metformin only, mode modification program lifestyle and risk factors (including references to diet and nutrition). , exercise counseling and cardiovascular risk factor management), or a combination of metformin and a lifestyle program.
Participants in the lifestyle groups received diet and exercise advice every 3 months in the first year and every 6 months in the second year. Although weight loss was observed in all groups except standard care, after one year none met activity or fitness goals.
This open-label study followed participants for up to 2 years, using implanted cardiac devices to track daily atrial fibrillation burden (the percentage of time participants experienced arrhythmia each day).
After one year, results showed that atrial fibrillation burden decreased over time in standard care, lifestyle and risk factor modification, and combined lifestyle and risk factor modification with metformin groups, while the metformin alone group initially showed a worsening trend before stabilizing.
However, no significant differences in changes in atrial fibrillation burden were observed between the 4 groups. Despite weight loss in all intervention groups (on average 2.4% in the metformin group, 2.1% in the lifestyle group, and 4.4% in the combined group), none achieved the study goal of 10% weight loss or improvement in physical fitness. Activity and exercise test results recorded on the device also showed no significant change in physical fitness.
Additionally, gastrointestinal side effects led more than a third of participants in the metformin groups to stop or avoid treatment. Notably, lifestyle modification groups reported improvements in atrial fibrillation symptom scores, highlighting the potential benefits of symptom relief through exercise and weight loss, although these strategies have not been effective. not reduce the burden of atrial fibrillation.
However, the study faced several limitations. First, its small sample size reduced its statistical power. Additionally, the onset of the COVID-19 pandemic during the study further complicated recruitment efforts and disrupted in-person visits. To address these challenges, the study protocol was adapted to include virtual visits and reduce the target sample size from 200 to 150 participants. Despite these adjustments, the disruptions may have impacted the consistency of interventions.
“We cannot at this time recommend metformin alone as an upstream treatment for atrial fibrillation, but there may be synergistic benefits with the combination arm, and the combination arm appears to produce some benefits, but we also have results at long term to 2 years expected,” Chung said.
The study’s two-year follow-up is expected to be completed in fall 2025, potentially providing additional information.
References
1. Changes in lifestyle and risk factors improved atrial fibrillation symptoms, not burden, compared with standard care. American Heart Association. Press release. November 18, 2024. Accessed December 5, 2024. https://newsroom.heart.org/news/lifestyle-risk-factor-changes-improved-afib-symptoms-not-burden-over-standard-care#:~:text=A%20clinical%20trial%20with%20adults , followed%20a%20lifestyle%2Frisk%20factor.