The most common side effects are abdominal discomfort and diarrhea, which are usually mild and transient. Less than 5% of patients do not tolerate metformin. Lactic Acidose rare (about three cases per 100,000 patient years), particularly sweat is respected contra-indications (Gross et al.) Metformin has partial contraindication in patients with renal insufficiency (creatinine 1.5 mg / dl in men and 1.4 mg / dl in women), grade IV congestive heart failure, chronic liver disease (transaminases 3 times the upper limit normal) and alcohol abuse. The drug should be discontinued during the surgical procedure, radiographic contrast and use of medical intercorrencia impairment (Gross et al.) Investigates the initial scientific studies originating prechamber protected LIGHT ( prevention of cardiovascular events. Indication of insulin sensitizer drug for diabetic patients, however, carriers of insulin resistance, increased abdominal circumference or obesidad.En the HOPE study (Heart Ouctomes Prevention Evaluation), it was found that the higher the abdominal great circles, the greater the rate of cardiovascular events, and the ARIC study (Atherosclerosis Risk in Communities) the Presence of metabolic syndrome increased the risk of doenca cardiovascular and cerebral vascular accident (CVA), especially women. The OAT trial (Occluder Artery Trial), the percutaneous Intervencao was higher than medical therapy increased the rate of myocardial infarction. Therefore, aggressive medical treatment is very effective in preventing major cardiovascular events (Fonseca F Astra Zeneca Symposium 2007).
The cutoff point for considering the increase depends on the great circle Populacao abdominal examination. The ATP III (Adult Treatment Panel III) provides values for men and women 102 cm 88 cm for women. The ampliacao in abdominal circumference becomes very important in the diagnosis of metabolic syndrome to be a marker of obesity intravisceral. Abdominal obesity is associated with ativacao of adipocytes, which cytokines that promote inflamacao Secretama, insulin resistance and increased free fatty Grax. These acids produced in the liver grax insulin resistance and LDL cholesterol elevacao. So the real issue is visceral obesity. (Steiner G Astra Zeneca Symposium 2007).
In the INTERHEART study, we observed that the ratio increased abdominal circumference / hip raises the risk of heart attack in level world, confirming the increased risk in Latin American Populacao. Insulin resistance and compensatory hyperinsulinemia are multiple causes of disorders such as central obesity, alteracao metabolism of carbohydrates and pro-coagulant states, resulting ultimately cardiovascular disease.