Utilisation de la metformine chez le patient diabetique cardiaque: balance benefices-risques.

Metformin is unanimously considered as the first-line glucose-lowering agent in type 2 diabetes. Theoretically, however, it cannot be prescribed in a large proportion of patients because of the presence of numerous contraindications corresponding to situations that may increase the risk of lactic acidosis. Recent data suggest that type 2 diabetes patients who are considered as being "at risk" because of the presence of cardiac disease still take benefit from metformin therapy, with a reduction of morbidity and mortality compared with other glucose-lowering agents. The present review analyzes the benefit-risk balance of metformin therapy in special populations, namely patients with stable coronary artery disease, acute coronary syndrome or myocardial infarction, or congestive heart failure.