Metformin modifies the exercise training effects on risk factors for cardiovascular disease in impaired glucose tolerant adults

Steven K Malin, Joy Nightingale, Sung-Eun Choi, Stuart R Chipkin, Barry Braun, Steven K Malin, Joy Nightingale, Sung-Eun Choi, Stuart R Chipkin, Barry Braun

Abstract

Impaired glucose tolerant (IGT) adults are at elevated risk for cardiovascular disease (CVD). Exercise or metformin reduce CVD risk, but the efficacy of combining treatments is unclear.

Objective: To determine the effects of exercise training plus metformin (EM), compared with each treatment alone, on CVD risk factors in IGT adults.

Design and methods: Subjects were assigned to placebo (P), metformin (M), exercise training plus placebo (EP), or EM (8/group). In a double-blind design, P or 2,000 mg/d of M were administered for 12 weeks and half performed aerobic and resistance training 3 days/week for ≈ 60 min/day at 70% pretraining heart rate peak. Outcomes included adiposity, blood pressure (BP), lipids, and high sensitivity C-reactive protein (hs-CRP). Z-scores were calculated to determine metabolic syndrome severity.

Results: M and EM, but not EP, decreased body weight compared with P (P < 0.05). M and EP lowered systolic blood pressure by 6% (P < 0.05), diastolic blood pressure by 6% (P < 0.05), and hs-CRP by 20% (M: trend P = 0.06; EP: P < 0.05) compared with P. Treatments raised high-density lipoprotein cholesterol (P < 0.05; EM: trend P = 0.06) compared with P and lowered triacyglycerol (P < 0.05) and metabolic syndrome Z-score compared with baseline (EP; trend P = 0.07 and EM or M; P < 0.05).

Conclusions: Although exercise and/or metformin improve some CVD risk factors, only training or metformin alone lowered hs-CRP and BP. Thus, metformin may attenuate the effects of training on some CVD risk factors and metabolic syndrome severity in IGT adults.

Copyright © 2012 The Obesity Society.

Figures

Figure 1a
Figure 1a
Change in body weight over the 12 week protocol. ^Significant effect of M and EM compared to P (p

Figure 1b

Change in waist circumference over…

Figure 1b

Change in waist circumference over the 12 week intervention. *Significant effect of time…

Figure 1b
Change in waist circumference over the 12 week intervention. *Significant effect of time (p

Figure 2a

Metabolic syndrome severity before and…

Figure 2a

Metabolic syndrome severity before and after the 12 week intervention. *Pre to post…

Figure 2a
Metabolic syndrome severity before and after the 12 week intervention. *Pre to post was statistically different by paired t-test; p $p = 0.07. Data are mean ± standard error of the mean.

Figure 2b

Metabolic syndrome prevalence before and…

Figure 2b

Metabolic syndrome prevalence before and after the 12 week intervention. Prevalence refers to…

Figure 2b
Metabolic syndrome prevalence before and after the 12 week intervention. Prevalence refers to the fraction of individuals with metabolic syndrome pre and post. *Pre to post was statistically different by McNemar; p

Figure 2c

ATP III score before and…

Figure 2c

ATP III score before and after the 12 week intervention. *Pre to post…

Figure 2c
ATP III score before and after the 12 week intervention. *Pre to post was statistically different by paired t-test; p
Similar articles
References
    1. Blake D, Meigs J, Muller D, Najjar S, Andres R, Nathan D. Impaired glucose tolerance, but not impaired fasting glucose, is associated with increased levels of coronary heart disease risk factors: results from the Baltimore Longitudinal Study on Aging. Diabetes. 2004;53(8):2095–2100. - PubMed
    1. Festa A, D'Agostino R, Howard G, Mykknen L, Tracy RP, Haffner SM. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS) Circulation. 2000;102(1):42–47. - PubMed
    1. Orchard TJ, Temprosa M, Goldberg R, Haffner S, Ratner R, Marcovina S, et al. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med. 2005;142(8):611–619. - PMC - PubMed
    1. Haffner S. Insulin resistance, inflammation, and the prediabetic state. Am J Cardiol. 2003;92(4A):18J–26J. - PubMed
    1. Unwin N, Shaw J, Zimmet P, Alberti KGMM. Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention. Diabetic Med. 2002;19(9):708–723. - PubMed
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Figure 1b
Figure 1b
Change in waist circumference over the 12 week intervention. *Significant effect of time (p

Figure 2a

Metabolic syndrome severity before and…

Figure 2a

Metabolic syndrome severity before and after the 12 week intervention. *Pre to post…

Figure 2a
Metabolic syndrome severity before and after the 12 week intervention. *Pre to post was statistically different by paired t-test; p $p = 0.07. Data are mean ± standard error of the mean.

Figure 2b

Metabolic syndrome prevalence before and…

Figure 2b

Metabolic syndrome prevalence before and after the 12 week intervention. Prevalence refers to…

Figure 2b
Metabolic syndrome prevalence before and after the 12 week intervention. Prevalence refers to the fraction of individuals with metabolic syndrome pre and post. *Pre to post was statistically different by McNemar; p

Figure 2c

ATP III score before and…

Figure 2c

ATP III score before and after the 12 week intervention. *Pre to post…

Figure 2c
ATP III score before and after the 12 week intervention. *Pre to post was statistically different by paired t-test; p
Similar articles
References
    1. Blake D, Meigs J, Muller D, Najjar S, Andres R, Nathan D. Impaired glucose tolerance, but not impaired fasting glucose, is associated with increased levels of coronary heart disease risk factors: results from the Baltimore Longitudinal Study on Aging. Diabetes. 2004;53(8):2095–2100. - PubMed
    1. Festa A, D'Agostino R, Howard G, Mykknen L, Tracy RP, Haffner SM. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS) Circulation. 2000;102(1):42–47. - PubMed
    1. Orchard TJ, Temprosa M, Goldberg R, Haffner S, Ratner R, Marcovina S, et al. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med. 2005;142(8):611–619. - PMC - PubMed
    1. Haffner S. Insulin resistance, inflammation, and the prediabetic state. Am J Cardiol. 2003;92(4A):18J–26J. - PubMed
    1. Unwin N, Shaw J, Zimmet P, Alberti KGMM. Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention. Diabetic Med. 2002;19(9):708–723. - PubMed
Show all 40 references
Publication types
MeSH terms
Full text links [x]
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Follow NCBI
Figure 2a
Figure 2a
Metabolic syndrome severity before and after the 12 week intervention. *Pre to post was statistically different by paired t-test; p $p = 0.07. Data are mean ± standard error of the mean.
Figure 2b
Figure 2b
Metabolic syndrome prevalence before and after the 12 week intervention. Prevalence refers to the fraction of individuals with metabolic syndrome pre and post. *Pre to post was statistically different by McNemar; p

Figure 2c

ATP III score before and…

Figure 2c

ATP III score before and after the 12 week intervention. *Pre to post…

Figure 2c
ATP III score before and after the 12 week intervention. *Pre to post was statistically different by paired t-test; p
Similar articles
References
    1. Blake D, Meigs J, Muller D, Najjar S, Andres R, Nathan D. Impaired glucose tolerance, but not impaired fasting glucose, is associated with increased levels of coronary heart disease risk factors: results from the Baltimore Longitudinal Study on Aging. Diabetes. 2004;53(8):2095–2100. - PubMed
    1. Festa A, D'Agostino R, Howard G, Mykknen L, Tracy RP, Haffner SM. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS) Circulation. 2000;102(1):42–47. - PubMed
    1. Orchard TJ, Temprosa M, Goldberg R, Haffner S, Ratner R, Marcovina S, et al. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med. 2005;142(8):611–619. - PMC - PubMed
    1. Haffner S. Insulin resistance, inflammation, and the prediabetic state. Am J Cardiol. 2003;92(4A):18J–26J. - PubMed
    1. Unwin N, Shaw J, Zimmet P, Alberti KGMM. Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention. Diabetic Med. 2002;19(9):708–723. - PubMed
Show all 40 references
Publication types
MeSH terms
Full text links [x]
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Figure 2c
Figure 2c
ATP III score before and after the 12 week intervention. *Pre to post was statistically different by paired t-test; p

References

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    1. Festa A, D'Agostino R, Howard G, Mykknen L, Tracy RP, Haffner SM. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS) Circulation. 2000;102(1):42–47.
    1. Orchard TJ, Temprosa M, Goldberg R, Haffner S, Ratner R, Marcovina S, et al. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med. 2005;142(8):611–619.
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