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Zhang X, Sun G, Li Z, Gao W, Tan W, Liu J, Zhang B, Wu J, Chen R, Li XJ, Zhang G. Effectiveness of Sodium-Glucose Cotransporter 2 Inhibitors in Patients With Acute Myocardial Infarction With or Without Type 2 Diabetes: A Systematic Review and Meta-analysis. J Cardiovasc Pharmacol 2024; 84:18-25. [PMID: 38968565 DOI: 10.1097/fjc.0000000000001576] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/26/2024] [Indexed: 07/07/2024]
Abstract
ABSTRACT Recent studies have revealed the benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in heart failure patients. However, their effects on acute myocardial infarction (AMI) remain uncertain. Therefore, we conducted this meta-analysis to assess the effectiveness of SGLT2i in patients with AMI with or without diabetes. We conducted a comprehensive search of PubMed, Embase, and Cochrane Library encompassing data from inception until November 30, 2023. Relevant studies comparing SGLT2i with placebo or non-SGLT2i in patients with AMI were included. The mean difference and/or odds ratio (OR) with 95% confidence intervals were pooled using a fixed-effects model when the heterogeneity statistic (I2) was less than 50%; otherwise, a random-effects model was employed. Four randomized controlled trials and 4 observational studies involving 9397 patients with AMI were included in this meta-analysis. Patients treated with SGLT2i exhibited a significantly lower rate of hospitalization for heart failure (OR = 0.50, 95% CI: 0.32-0.80) and all-cause death (OR = 0.65, 95% CI: 0.44-0.95) compared with those treated with placebo or non-SGLT2i. Furthermore, the use of SGLT2i was associated with a significant increase in left ventricular ejection fraction (mean difference = 1.90, 95% CI: 1.62-2.17) and a greater reduction of N-terminal prohormone of brain natriuretic peptide (OR = 0.88, 95% CI 0.82-0.94). Subgroup analysis revealed that in patients with diabetes, SGLT2i exhibited similar effects. The present meta-analysis provided evidence indicating the effectiveness of SGLT2i in patients with AMI; SGLT2i may serve as an additional therapeutic option for patients with AMI, regardless of the presence or absence of diabetes.
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Affiliation(s)
- Xuefang Zhang
- Department of Cardiology, Jiangmen Central Hospital, Jiangmen, PR China
| | - Gang Sun
- Department of Cardiology, Jiangmen Central Hospital, Jiangmen, PR China
| | - Zhiquan Li
- Department of Emergency, Jiangmen Central Hospital, Jiangmen, PR China; and
| | - Weidong Gao
- Department of Cardiology, Jiangmen Central Hospital, Jiangmen, PR China
| | - Wenfeng Tan
- Department of Cardiology, Jiangmen Central Hospital, Jiangmen, PR China
| | - Jinxue Liu
- Department of Cardiology, Jiangmen Central Hospital, Jiangmen, PR China
| | - Bin Zhang
- Department of Cardiology, Jiangmen Central Hospital, Jiangmen, PR China
| | - Juan Wu
- Department of Cardiology, Jiangmen Central Hospital, Jiangmen, PR China
| | - Rong Chen
- Department of Cardiology, Jiangmen Central Hospital, Jiangmen, PR China
| | - Xiu Juan Li
- Department of Laboratory, Jiangmen Central Hospital, Jiangmen, PR China
| | - Gaoxing Zhang
- Department of Cardiology, Jiangmen Central Hospital, Jiangmen, PR China
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Udell JA, Jones WS, Petrie MC, Harrington J, Anker SD, Bhatt DL, Hernandez AF, Butler J. Sodium Glucose Cotransporter-2 Inhibition for Acute Myocardial Infarction: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 79:2058-2068. [PMID: 35589167 DOI: 10.1016/j.jacc.2022.03.353] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 12/15/2022]
Abstract
Sodium glucose cotransporter-2 (SGLT2) inhibitors improve cardiorenal outcomes in patients with type 2 diabetes mellitus, chronic kidney disease, and chronic heart failure. SGLT2 inhibitors also reduce the risk of cardiovascular mortality and hospitalization for heart failure among patients with type 2 diabetes mellitus and a remote history of myocardial infarction (MI). As a result of the growing body of evidence in diverse disease states, and the hypothesized mechanisms of action, it is reasonable to consider the potential of SGLT2 inhibition to improve outcomes in patients with acute MI as well if initiated early after presentation. Whether these therapies are efficacious and safe to use early in the course of acute coronary heart disease remains relatively unexplored. Here, we describe the contemporary data and continuing evidence gap for considering the use of SGLT2 inhibitors early following an acute MI to reduce cardiovascular morbidity and mortality.
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Affiliation(s)
- Jacob A Udell
- Women's College Hospital and Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - W Schuyler Jones
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Josephine Harrington
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Center for Regenerative Therapies, German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas, USA; University of Mississippi, Jackson, Mississippi, USA
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Wang L, Pan J, Sun Y, Zong S, Zhang R, Li Y, Yu Z, Liu J, Zang S. Increased Neutrophil elastase and proteinase 3 are closely associated with occurrence and severity of stroke and acute myocardial infarction in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2022; 186:109853. [PMID: 35341779 DOI: 10.1016/j.diabres.2022.109853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/07/2022] [Accepted: 03/22/2022] [Indexed: 11/03/2022]
Abstract
AIMS The role of Neutrophil elastase (NE) and proteinase 3 (PR3) in the occurrence and severity of stroke and acute myocardial infarction (AMI) have not been explored in type 2 diabetes mellitus (T2DM). This study aimed to investigate the relationship and predictive ability of NE and PR3 in the development of stroke and AMI in patients with T2DM, and to explore the pattern of NE and PR3 in atherosclerotic plaques. METHODS 465 patients with T2DM (stroke or AMI, n = 234; non stroke or AMI, n = 231) were recruited. Clinical characteristics, and NE and PR3 concentration were measured in all subjects. Semi-quantitative analysis of immunohistochemistry staining for NE and PR3 was performed in detached emboli and stable plaques. RESULTS Patients with stroke or AMI had a higher level of NE and PR3, with a more pronounced increase in more severe cases (higher mRS score in stroke and Gensini score in AMI) and associated with clinical markers. An increase in NE and PR3 was an independent risk factor for stroke (OR = 4.318, P = 0.017; OR = 2.979, P = 0.048, respectively) and AMI (OR = 8.385, P = 0.015; OR = 5.540, P = 0.047). Finally, immunohistochemistry staining revealed that the NE and PR3 positive area increased significantly in detached emboli compared with stable plaques. CONCLUSION Increased NE and PR3 was associated with occurrence and severity of stroke and AMI in patients with T2DM. Enriched NE and PR3 in detached emboli may be associated with plaque vulnerability.
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Affiliation(s)
- Lihong Wang
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqin Road, Shanghai 200240, China
| | - Jie Pan
- Department of General Surgery, Shanghai Fifth People's Hospital, Fudan University, 801 Heqin Road, Shanghai 200240, China
| | - Yifan Sun
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqin Road, Shanghai 200240, China
| | - Shuhang Zong
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqin Road, Shanghai 200240, China
| | - Rui Zhang
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqin Road, Shanghai 200240, China
| | - Yue Li
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqin Road, Shanghai 200240, China
| | - Zhiyan Yu
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqin Road, Shanghai 200240, China
| | - Jun Liu
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqin Road, Shanghai 200240, China
| | - Shufei Zang
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqin Road, Shanghai 200240, China.
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Ferreira JP, Rossignol P, Bakris G, Mehta C, White WB, Zannad F. Body weight changes in patients with type 2 diabetes and a recent acute coronary syndrome: an analysis from the EXAMINE trial. Cardiovasc Diabetol 2021; 20:187. [PMID: 34521390 PMCID: PMC8442423 DOI: 10.1186/s12933-021-01382-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/07/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Patients with type 2 diabetes (T2D) may experience frequent body weight changes over time. The prognostic impact of these weight changes (gains or losses) requires further study. AIMS To study the associations between changes in body weight (intentional or unintentional) with subsequent outcomes. METHODS The EXAMINE trial included 5380 patients with T2D and a recent acute coronary syndrome, who were randomized to alogliptin or placebo. Time-updated Cox models and mixed effects models were used to test the associations between changes in body weight and subsequent outcomes over a median follow-up of 1.6 (1.0-2.1) years. RESULTS During the post-randomization follow-up period, 1044 patients (19.4%) experienced a weight loss ≥ 5% of baseline weight, 2677 (49.8%) had a stable weight, and 1659 (30.8%) had a ≥ 5 % weight gain. Patients with weight loss were more frequently women and had more co-morbid conditions. In contrast, patients who gained ≥ 5% weight were more frequently men with less co-morbid conditions. A weight loss ≥ 5% was independently associated with a higher risk of subsequent adverse outcomes, including all-cause mortality: adjusted HR (95% CI) = 1.79 (1.33-2.42), P < 0.001. Similar associations were found for cardiovascular mortality, the composite of cardiovascular mortality or heart failure hospitalization, and the primary outcome. A weight gain ≥ 5% was independently associated with an increase in the risk of subsequent cardiovascular mortality or heart failure hospitalization only: adjusted HR (95% CI) = 1.34 (1.02-1.76), P = 0.033. CONCLUSIONS In patients with T2D who had a recent ACS/MI, a ≥ 5% loss of body weight was associated with a higher risk of subsequent cardiovascular events and mortality.
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Affiliation(s)
- João Pedro Ferreira
- Centre DInvestigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy hopitaux de Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, 4 Rue du Morvan, 54500, Vandoeuvre lès Nancy, France. .,Cardiovascular Research and Development Center, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Patrick Rossignol
- Centre DInvestigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy hopitaux de Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, 4 Rue du Morvan, 54500, Vandoeuvre lès Nancy, France
| | - George Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, University of Chicago, Chicago, IL, USA
| | | | - William B White
- Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Faiez Zannad
- Centre DInvestigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy hopitaux de Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, 4 Rue du Morvan, 54500, Vandoeuvre lès Nancy, France
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Ferreira JP, Lamiral Z, Bakris G, Mehta C, White WB, Zannad F. Red cell distribution width in patients with diabetes and myocardial infarction: An analysis from the EXAMINE trial. Diabetes Obes Metab 2021; 23:1580-1587. [PMID: 33687751 DOI: 10.1111/dom.14371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 12/16/2022]
Abstract
AIM To determine the clinical correlates of increased red blood cell distribution width (RDW), its potential mechanistic association with multiple circulating biomarkers, and its prognostic value in patients with type 2 diabetes (T2D) who had a recent acute coronary syndrome. METHODS We used time-updated Cox models applied to patients enrolled in the Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care (EXAMINE) trial. RESULTS A total of 5380 patients were included, the median age was 61 years and 32% were women. Patients with higher RDW were older, more frequently women, with a longer diabetes duration and increased co-morbidities. An RDW of more than 16.1% (both baseline and time-updated) was independently associated with the study primary composite outcome of non-fatal myocardial infarction, non-fatal stroke or cardiovascular death (time-updated adjusted HR = 1.36, 95% CI = 1.16-1.61, p < .001), all-cause death (time-updated adjusted HR = 2.01, 95% CI = 1.60-2.53, p < .001), as well as mortality from non-cardiovascular causes (time-updated adjusted HR = 2.67, 95% CI = 1.72-4.15, p < .001). RDW had a weak-to-moderate correlation with haemoglobin and circulating markers that reflected inflammation, apoptosis, fibrosis and congestion. Alogliptin did not alter RDW values. CONCLUSIONS RDW is a marker of disease severity associated with a multitude of poor outcomes, including both cardiovascular and non-cardiovascular death. RDW correlated modestly with inflammatory, pro-apoptotic, pro-fibrotic and congestion markers, and its levels were not affected by alogliptin during the course of the trial.
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Affiliation(s)
- João Pedro Ferreira
- Centre d'Investigations Cliniques Plurithématique Inserm 1433, Université de Lorraine, CHRU de Nancy, Inserm U1116, FCRIN INI-CRCT, Nancy, France
| | - Zohra Lamiral
- Centre d'Investigations Cliniques Plurithématique Inserm 1433, Université de Lorraine, CHRU de Nancy, Inserm U1116, FCRIN INI-CRCT, Nancy, France
| | - George Bakris
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | | | - William B White
- Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Faiez Zannad
- Centre d'Investigations Cliniques Plurithématique Inserm 1433, Université de Lorraine, CHRU de Nancy, Inserm U1116, FCRIN INI-CRCT, Nancy, France
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