Metformin and Its Potential for Heart Failure with Preserved Ejection Fraction

The health burden of Heart Failure with Preserved Ejection Fraction (HFpEF) is substantial. In some countries, HFpEF is the leading cause of hospital admission in patients over 65 years of age and is predicted to be the leading cause of mortality within a decade [1,2]. HFpEF is characterised by reduced exercise capacity and ability to engage in activities of daily living, poor HealthRelated Quality of Life (HRQoL), high rates of hospitalisation, and premature mortality [3]. In sharp contrast to the wealth of proven therapies for Heart Failure with Reduced Ejection Fraction (HFrEF) that have improved mortality and morbidity, there is a distinct lack of treatment options for HFpEF. Drugs or devices which are recommended in current HF treatment guidelines to improve outcomes in HFrEF have not been shown to have similar benefit in HFpEF patients, and to date, phase III randomised controlled trials have not consistently yielded evidence-based therapy for HFpEF [4]. The lack of treatment options in patients with HFpEF represents a significant unmet need that urgently demand new therapeutic strategies that arguably target mechanisms specific for HFpEF.