for people ages 18 years and up (full criteria)
at San Diego, California and other locations
study started
completion around



This research will help us to learn if the medicine called metformin reduces the risk of death, heart attacks, and/or strokes in patients who have pre-diabetes and heart or blood vessel problems.

Official Title

CSP #2002 - Investigation of Metformin in Pre-Diabetes on Atherosclerotic Cardiovascular OuTcomes (VA-IMPACT)


CSP #2002 is a multicenter, prospective, randomized, double blind, secondary prevention trial to test the hypothesis that treatment with metformin, compared with placebo, reduces mortality and cardiovascular morbidity in patients with pre-diabetes and established atherosclerotic cardiovascular disease. Qualifying patients have pre-diabetes defined by HbA1c, fasting blood glucose, or oral glucose tolerance test criteria; clinically evident coronary, cerebrovascular, or peripheral arterial atherosclerotic cardiovascular disease; and estimated glomerular filtration rate of at least 45 mL/min/1.73 m2; and do not fulfill any exclusion criteria. Patients who are eligible and agree to participate are randomly assigned to treatment with metformin XR (titrated to a maximum dose of 2000 mg daily based on safety and tolerability) or matching placebo. All patients receive counseling on therapeutic lifestyle recommendations.

CSP #2002 had a Pilot Phase trial from 2/2019 to 1/2021 and was approved for the full-scale trial, with projected full-scale launch in 10/2022.


Prediabetic State, Atherosclerosis, Metformin, Hemoglobin A, Glycosylated, Coronary Artery Disease, Peripheral Arterial Disease, Cerebrovascular Disorders, Metformin XR


You can join if…

Open to people ages 18 years and up

  1. Pre-diabetes: This condition is fulfilled by HbA1c of at least 5.7%, but less than 6.5%; or two measurements of fasting plasma glucose (on separate days) of 100-125 mg/dL; or a 2-hour plasma glucose level of 140-199 mg/dL following a 75 g glucose load oral glucose tolerance test.
  2. Established atherosclerotic cardiovascular disease: Qualifying participants must have evidence of atherosclerotic disease in at least one of the following vascular beds: coronary, cerebrovascular, or peripheral arterial circulation.

    Coronary artery disease is fulfilled by at least one of (1), (2), or (3):

  3. History of myocardial infarction at least one month prior to randomization.
  4. History of percutaneous coronary intervention or coronary artery bypass surgery at least one month prior to randomization.
  5. Angiographic evidence of coronary stenosis of at least 50% in at least two major epicardial coronary arteries.

    Cerebrovascular disease is fulfilled by at least one of criteria (1) through (4):

  6. Documented prior ischemic stroke (at least one month prior to randomization),
  7. Carotid artery stenosis 50% and history of transient ischemic attack or transient ischemic visual symptoms attributable to the identified lesion(s),
  8. Asymptomatic carotid stenosis of at least 70% luminal diameter,
  9. History of carotid revascularization (surgical or catheter-based).

    Peripheral arterial disease: Fulfilled by at least one of the following:

  10. History of aorto-iliac or peripheral artery intervention (surgical or catheter based) for limb ischemia, or amputation for limb ischemia,
  11. Symptoms of intermittent claudication with ankle:brachial index less than or equal to 0.85.

    3. Renal function: Estimated glomerular filtration rate at least 45 mL/min/1.73 m2. 4. Informed consent has been fully executed, and participant agrees to study procedures.

You CAN'T join if...

  1. Treatment with metformin or other anti-diabetic medication within 12 months of randomization. Note: In the absence of a diagnosis of diabetes, inpatient treatment with insulin or treatment with an SGLT2 inhibitor (e.g., for heart failure) or a GLP-1 receptor agonist (e.g., for obesity) is not exclusionary.
  2. Treatment with systemic glucocorticoids within 3 months of randomization
  3. Fasting plasma glucose 140 mg/dL measured between screening and randomization visits, or any plasma glucose 200 mg/dL or HbA1c 7.0% measured within 12 months of randomization.
  4. Total CO2 below the local laboratory lower limit of normal on most recent blood chemistry panel
  5. Current treatment with cimetidine, vandetanib, or a systemic treatment with a carbonic anhydrase inhibitor.
  6. Cirrhosis, active hepatitis, or jaundice at time of randomization, or total bilirubin > 2 times upper limit of normal
  7. Binge or heavy alcohol consumption within 6 months of randomization
  8. Severe anemia (hemoglobin < 10 g/dL)
  9. Prior history of intolerance to metformin

    10. Myocardial infarction, coronary revascularization procedure, or stroke within 1 month

    of randomization

    11. Uncontrolled hypertension at screening assessment (systolic blood pressure 180 mm Hg

    or diastolic blood pressure 110 mm Hg

    12. Acute or decompensated congestive heart failure 13. Expected survival less than study duration 14. Participants considered to be unable, unwilling, or unreliable to meet protocol


    15. Impaired decision-making capacity, defined by any history of dementia or cognitive


    16. Concurrent participation in another research study involving a randomized comparison

    of drug or device treatments, unless specifically excepted.

    17. Pregnant, intent to become pregnant during the trial, or lactating 18. Women of childbearing potential who are not using a highly effective method of



  • VA San Diego Healthcare System, San Diego, CA accepting new patients
    San Diego California 92161-0002 United States
  • VA Loma Linda Healthcare System, Loma Linda, CA accepting new patients
    Loma Linda California 92357-1000 United States


accepting new patients
Start Date
Completion Date
VA Office of Research and Development
Phase 4 research study
Study Type
Expecting 7410 study participants
Last Updated