Metformina e cardioproteção: perspectivas do tratamento do diabetes mellitus tipo 2 e insuficiência cardíaca

Abstract

Diabetes mellitus (DM) is a global epidemic that poses a significant challenge for healthcare systems. DM is a metabolic disorder characterized by persistent hyperglycemia resulting from a deficiency in insulin production and/or action. Type 2 diabetes mellitus (T2DM) is the most prevalent form, with risk factors including population aging, unhealthy lifestyles, physical inactivity, and obesity. Among the complications of diabetes are cardiac alterations, particularly heart failure (HF). Proper management of T2DM is crucial to reduce undesirable cardiovascular outcomes. In this context, pharmacological therapy plays a vital role. Metformin, a biguanide class medication, is the first-line treatment for T2DM. Metformin holds substantial clinical importance in aiding the reduction of cardiovascular complications associated with the disease. AMPK (adenosine monophosphate-activated protein kinase) is an important energy regulator whose activation by metformin underlies its hypoglycemic action and is also associated with cardioprotection. This enzyme acts as a metabolic sensor, coordinating cellular anabolic and catabolic processes to promote the health and survival of cardiomyocytes. The primary pharmacological mechanisms of metformin's cardioprotective action include reductions in blood glucose levels, total cholesterol, triglycerides, and LDL cholesterol, as well as the reduction of oxidative stress markers and improvement in endothelial function and hemeostasis. Hence, this literature review aims at examining the cardioprotective mechanisms of metformin, with an emphasis on T2DM and HF as prevalent complications. and to review clinical studies on this topic. The databases Google Scholar, Scielo, Pubmed, and Portal Capes were searched with the following keywords: T2DM, HF, metformin, HF and metformin, cardioprotection of metformin, and metformin and AMPK.