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From the UKPDS it was concluded that metformin decreased cardiac events.  However, this only occurred in a small group of obese subjects while in a larger group failing sulfonylurea therapy the addition of metformin resulted in an increase in cardiac events [1].  Indeed, a meta-analysis of metformin studies has shown that overall metformin does not decrease cardiac events.  However, if in this meta-analysis the group utilizing metformin and sulfonylurea combinations were removed from the analysis then there was a significant decrease in cardiac events with metformin monotherapy[2]. The major decrease in cardiac events, cardiac mortality and total mortality with metformin is likely due to a decreased susceptibility to develop heart failure.  From Medicare billing records of 16,417 diabetic patients with heart failure discharged from hospital on metformin were compared to those with heart failure discharged on a sulfonylurea or insulin, mortality was reduced by 13% and readmission by 8%

Mechanisms by which Metformin Improves Mortality and Hospital Readmission in Diabetic Patients with Heart Failure