Evidence map›Metformin × cardiac & vascular function›PMID 24622715›Full record

Trial reportThe lancet. Diabetes & endocrinology2014

Metformin for non-diabetic patients with coronary heart disease (the CAMERA study): a randomised controlled trial.

David Preiss, Suzanne M Lloyd, Ian Ford, John J McMurray, Rury R Holman, Paul Welsh, Miles Fisher, Chris J Packard, Naveed Sattar

3 registry-linked trialsOpen access · hybridAbstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in The lancet. Diabetes & endocrinology, 2014. The graph read 1 number from its abstract, feeding 1 cell of the map: it finds no clear difference in 1. It reports registered trial NCT00723307. Cited by 92 papers, 7 of them syntheses that pooled it.

1number the graph read from it
1cell of the map it votes in
92citing papers in PubMed, 7 pooled it
9.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

← favours the treatmentfavours the comparator →
0.020 · no effect
Cardiac & vascular functionno clear difference · against placebo · ascvd, t2dfeeds one cell of the map
Δ 0.02p=0.29
At baseline, mean cIMT was 0.717 mm (SD 0.129) and mean carotid plaque score was 2.43 (SD 1.55). cIMT progression did not differ significantly between groups (slope difference 0.007 mm per year, 95% CI -0.006 to 0.020; p=0.29).
FeedsMetformin×cardiac & vascular function

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Metformin×cardiac & vascular function

InconclusiveOpen on the map →What to test next →

4 readable studies in this cell: 1 favour the treatment, 3 find no difference, 0 favour the comparator.

Belief with this paper
0.24contested · 1 family supports, 3 contradict · against placebo
Without it
0.24This paper does not move the number.
← favours the comparatorfavours the treatment →
0 · no effect
This paper173 enrolled · 2009
Δ 0.02
NCT0335546991 enrolled · 2017
Δ 3.530.08 to 6.99
NCT0047387662 enrolled · 2007
Δ -0.38
NCT0334977521 enrolled · 2017
Δ -2.57-8.32 to 3.18
4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00723307 phase4completed

A Randomised Placebo-controlled Trial of Metformin on Progression of Carotid Atherosclerosis in Non-diabetic Patients With Cardiovascular Disease Treated With Conventional Risk Reducing Agents

Ran2009Enrolled173Registered outcomes4Posted comparisons0ConditionsCoronary Artery DiseaseArmsMetformin, Placebo
Open the trial in the graph
NCT04267809 phase2completednot on this mapstarted 2021, after this paper: background citation

Modulating Endoplasmic Reticulum Stress as a Prophylactic Approach Against Symptomatic Viral Infection

TypeinterventionalSponsorSingapore General HospitalRan2021 to 2023Enrolled32ConditionsEndoplasmic Reticulum Stress, Viral Infection, Yellow FeverArmsMetformin Hydrochloride, Calcium and Vitamin D
NCT07688694 naenrolling by invitationnot on this mapstarted 2026, after this paper: background citation

Evaluation of Boiled Water Extracts of Legumes Seed Coats for Alpha Amylase and Alpha Glucosidase Activity: Formulation of Anti- Diabetic Nutraceuticals

TypeinterventionalSponsorJSS MEDICAL COLLEGE, JSS ACADEMY OF HIGHER EDUCATION AND RESEARCHRan2026 to 2027Enrolled100ConditionsPostprandial Hyperglycemia, Type 2 Diabetes, Metabolic SyndromesArmsLegumes seed soup
5 · Its place in the literature

Who cites it

92 citing papers in PubMed, 7 syntheses or guidelines pooled it, 196 citations in OpenAlex.

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  14. Two-year follow-up of 4 months metformin treatment vs. placebo in ST-elevation myocardial infarction: data from the GIPS-III RCT.Clinical research in cardiology : official journal of the German Cardiac Society · 2017
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32 more citing papers are in PubMed but not listed here.

6 · The record

Corrections and comments

7 · Who and what money

Authors and funding

9 authors at 4 institutions in 1 country.

David PreissBHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK. Electronic address: david.preiss@glasgow.ac.uk.
Suzanne M LloydRobertson Centre for Biostatistics, University of Glasgow, Glasgow, UK.
Ian FordRobertson Centre for Biostatistics, University of Glasgow, Glasgow, UK.
John J McMurrayBHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Rury R HolmanDiabetes Trials Unit, University of Oxford, Oxford, UK.
Paul WelshBHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Miles FisherDepartment of Diabetes, Glasgow Royal Infirmary, Glasgow, UK.
Chris J PackardGlasgow Clinical Research Facility, Tennent Building, Western Infirmary, Glasgow, UK.
Naveed SattarBHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
University of Glasgow · GBGlasgow Royal Infirmary · GBUniversity of Oxford · GBWestern Infirmary · GB

Funding

Chief Scientist Office CZB/4/613
8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

backgroundMetformin reduces cardiovascular risk in patients with type 2 diabetes seemingly independent of lowering blood glucose concentration. We assessed the cardiovascular effects of metformin in individuals without type 2 diabetes.

methodsWe did a single-centre, double-blind, placebo-controlled trial at the Glasgow Clinical Research Facility (Glasgow, UK). We enrolled patients taking statins who did not have type 2 diabetes but who did have coronary heart disease and large waist circumferences. Participants were randomly assigned (1:1) by computer to either metformin (850 mg twice daily) or matching placebo in block sizes of four. Patients, investigators, trial staff, and statisticians were masked to treatment allocation. The primary endpoint was progression of mean distal carotid intima-media thickness (cIMT) over 18 months in the modified intention-to-treat population. Secondary endpoints were changes in carotid plaque score (in six regions), measures of glycaemia (HbA1c, fasting glucose, and insulin concentrations, and Homeostasis Model Assessment of Insulin Resistance [HOMA-IR]), and concentrations of lipids, high sensitivity C-reactive protein, and tissue plasminogen activator. The trial was registered at ClinicalTrials.gov, number NCT00723307.

findingsWe screened 356 patients, of whom we enrolled 173 (86 in the metformin group, 87 in the placebo group). Average age was 63 years. At baseline, mean cIMT was 0·717 mm (SD 0·129) and mean carotid plaque score was 2·43 (SD 1·55). cIMT progression did not differ significantly between groups (slope difference 0·007 mm per year, 95% CI -0·006 to 0·020; p=0·29). Change of carotid plaque score did not differ significantly between groups (0·01 per year, 95% CI -0·23 to 0·26; p=0·92). Patients taking metformin had lower HbA1c, insulin, HOMA-IR, and tissue plasminogen activator compared with those taking placebo, but there were no significant differences for total cholesterol, HDL-cholesterol, non-HDL-cholesterol, triglycerides, high sensitivity C-reactive protein, or fasting glucose. 138 adverse events occurred in 64 patients in the metformin group versus 120 in 60 patients in the placebo group. Diarrhoea and nausea or vomiting were more common in the metformin group than in the placebo group (28 vs 5).

interpretationMetformin had no effect on cIMT and little or no effect on several surrogate markers of cardiovascular disease in non-diabetic patients with high cardiovascular risk, taking statins. Further evidence is needed before metformin can be recommended for cardiovascular benefit in this population.

fundingChief Scientist Office (Scotland).

Indexed as

Carotid Intima-Media ThicknessAgedBlood GlucoseCoronary DiseaseDouble-Blind MethodFemaleHumansHypoglycemic AgentsInsulin ResistanceMaleMetforminMiddle AgedTunica IntimaWaist CircumferenceBlood GlucoseHypoglycemic AgentsMetformin

Identifiers

PMID24622715
OpenAlexW2140307562

What OpenQuestion holds

Texttitle and abstract
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.