1
|
Berezin AE, Berezina TA, Hoppe UC, Lichtenauer M, Berezin AA. Methods to predict heart failure in diabetes patients. Expert Rev Endocrinol Metab 2024; 19:241-256. [PMID: 38622891 DOI: 10.1080/17446651.2024.2342812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is one of the leading causes of cardiovascular disease and powerful predictor for new-onset heart failure (HF). AREAS COVERED We focus on the relevant literature covering evidence of risk stratification based on imaging predictors and circulating biomarkers to optimize approaches to preventing HF in DM patients. EXPERT OPINION Multiple diagnostic algorithms based on echocardiographic parameters of cardiac remodeling including global longitudinal strain/strain rate are likely to be promising approach to justify individuals at higher risk of incident HF. Signature of cardiometabolic status may justify HF risk among T2DM individuals with low levels of natriuretic peptides, which preserve their significance in HF with clinical presentation. However, diagnostic and predictive values of conventional guideline-directed biomarker HF strategy may be non-optimal in patients with obesity and T2DM. Alternative biomarkers affecting cardiac fibrosis, inflammation, myopathy, and adipose tissue dysfunction are plausible tools for improving accuracy natriuretic peptides among T2DM patients at higher HF risk. In summary, risk identification and management of the patients with T2DM with established HF require conventional biomarkers monitoring, while the role of alternative biomarker approach among patients with multiple CV and metabolic risk factors appears to be plausible tool for improving clinical outcomes.
Collapse
Affiliation(s)
- Alexander E Berezin
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Tetiana A Berezina
- VitaCenter, Department of Internal Medicine & Nephrology, Zaporozhye, Ukraine
| | - Uta C Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | | |
Collapse
|
2
|
Agarawal K, Anant Kulkarni Y, Wairkar S. Nanoformulations of flavonoids for diabetes and microvascular diabetic complications. Drug Deliv Transl Res 2023; 13:18-36. [PMID: 35637334 DOI: 10.1007/s13346-022-01174-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 12/13/2022]
Abstract
Diabetes is a chronic metabolic disease characterized by an excess of glucose in the blood. If the constant sugar level is not managed correctly in diabetic patients, it may lead to microvascular complications such as diabetic retinopathy, neuropathy, and nephropathy. There are several synthetic drugs for the management of diabetes; however, these drugs produce immense adverse effects in long-term use. Flavonoids are naturally occurring substances categorized in various classes. They are known for their diverse pharmacological actions, and one of them is prominent antihyperglycemic action and their activities in diabetic complications. In the last few decades, many research studies emphasized the potential of flavonoids in diabetes management. Nevertheless, most flavonoids are insoluble in water and cannot produce desired therapeutic action when administered in conventional dosage forms. To overcome this issue, flavonoids were formulated into different nanoformulations to enhance solubility, absorption, and therapeutic efficacy. This review article focuses on flavonoid nanoformulations and in vitro and in vivo studies reported to overcome diabetes mellitus and its complications.
Collapse
Affiliation(s)
- Kopal Agarawal
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKMs NMIMS, V.L.Mehta Road, Vile Parle (W), Mumbai, Maharashtra, 400056, India
| | - Yogesh Anant Kulkarni
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKMs NMIMS, V.L.Mehta Road, Vile Parle (W), Mumbai, Maharashtra, 400056, India
| | - Sarika Wairkar
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKMs NMIMS, V.L.Mehta Road, Vile Parle (W), Mumbai, Maharashtra, 400056, India.
| |
Collapse
|
3
|
Razaghizad A, Oulousian E, Randhawa VK, Ferreira JP, Brophy JM, Greene SJ, Guida J, Felker GM, Fudim M, Tsoukas M, Peters TM, Mavrakanas TA, Giannetti N, Ezekowitz J, Sharma A. Clinical Prediction Models for Heart Failure Hospitalization in Type 2 Diabetes: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2022; 11:e024833. [PMID: 35574959 PMCID: PMC9238543 DOI: 10.1161/jaha.121.024833] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/03/2022] [Indexed: 12/20/2022]
Abstract
Background Clinical prediction models have been developed for hospitalization for heart failure in type 2 diabetes. However, a systematic evaluation of these models' performance, applicability, and clinical impact is absent. Methods and Results We searched Embase, MEDLINE, Web of Science, Google Scholar, and Tufts' clinical prediction registry through February 2021. Studies needed to report the development, validation, clinical impact, or update of a prediction model for hospitalization for heart failure in type 2 diabetes with measures of model performance and sufficient information for clinical use. Model assessment was done with the Prediction Model Risk of Bias Assessment Tool, and meta-analyses of model discrimination were performed. We included 15 model development and 3 external validation studies with data from 999 167 people with type 2 diabetes. Of the 15 models, 6 had undergone external validation and only 1 had low concern for risk of bias and applicability (Risk Equations for Complications of Type 2 Diabetes). Seven models were presented in a clinically useful manner (eg, risk score, online calculator) and 2 models were classified as the most suitable for clinical use based on study design, external validity, and point-of-care usability. These were Risk Equations for Complications of Type 2 Diabetes (meta-analyzed c-statistic, 0.76) and the Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (meta-analyzed c-statistic, 0.78), which was the simplest model with only 5 variables. No studies reported clinical impact. Conclusions Most prediction models for hospitalization for heart failure in patients with type 2 diabetes have potential concerns with risk of bias or applicability, and uncertain external validity and clinical impact. Future research is needed to address these knowledge gaps.
Collapse
Affiliation(s)
- Amir Razaghizad
- Centre for Outcomes Research and EvaluationResearch Institute of the McGill University Health CentreMontrealQCCanada
- Division of CardiologyMcGill University Health CentreMcGill UniversityMontrealQuebecCanada
- DREAM‐CV LaboratoryMcGill University Health CentreMcGill UniversityMontrealQuebecCanada
| | - Emily Oulousian
- DREAM‐CV LaboratoryMcGill University Health CentreMcGill UniversityMontrealQuebecCanada
| | - Varinder Kaur Randhawa
- Department of Cardiovascular MedicineKaufman Center for Heart Failure and RecoveryHeart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | - João Pedro Ferreira
- University of LorraineInserm, Centre d'Investigations Cliniques, ‐ Plurithématique 14‐33, Inserm U1116CHRUF‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)NancyFrance
- Department of Surgery and PhysiologyCardiovascular Research and Development CenterFaculty of Medicine of the University of PortoPortoPortugal
| | - James M. Brophy
- Centre for Outcomes Research and EvaluationResearch Institute of the McGill University Health CentreMontrealQCCanada
- Division of CardiologyMcGill University Health CentreMcGill UniversityMontrealQuebecCanada
| | - Stephen J. Greene
- Division of CardiologyDuke University School of MedicineDurhamNC
- Duke Clinical Research InstituteDurhamNC
| | - Julian Guida
- DREAM‐CV LaboratoryMcGill University Health CentreMcGill UniversityMontrealQuebecCanada
| | - G. Michael Felker
- Division of CardiologyDuke University School of MedicineDurhamNC
- Duke Clinical Research InstituteDurhamNC
| | - Marat Fudim
- Division of CardiologyDuke University School of MedicineDurhamNC
- Duke Clinical Research InstituteDurhamNC
| | - Michael Tsoukas
- Division of EndocrinologyDepartment of MedicineMcGill UniversityMontrealQCCanada
| | - Tricia M. Peters
- Division of EndocrinologyDepartment of MedicineMcGill UniversityMontrealQCCanada
- Centre for Clinical EpidemiologyLady Davis Institute for Medical ResearchMontrealQCCanada
| | - Thomas A. Mavrakanas
- Division of NephrologyDepartment of MedicineMcGill University Health Centre and Research InstituteMontrealCanada
| | - Nadia Giannetti
- Division of CardiologyMcGill University Health CentreMcGill UniversityMontrealQuebecCanada
| | - Justin Ezekowitz
- Division of CardiologyUniversity of AlbertaEdmontonAlbertaCanada
| | - Abhinav Sharma
- Centre for Outcomes Research and EvaluationResearch Institute of the McGill University Health CentreMontrealQCCanada
- Division of CardiologyMcGill University Health CentreMcGill UniversityMontrealQuebecCanada
- DREAM‐CV LaboratoryMcGill University Health CentreMcGill UniversityMontrealQuebecCanada
| |
Collapse
|
4
|
Sharma A, Zheng Y, Ezekowitz JA, Westerhout CM, Udell JA, Goodman SG, Armstrong PW, Buse JB, Green JB, Josse RG, Kaufman KD, McGuire DK, Ambrosio G, Chuang LM, Lopes RD, Peterson ED, Holman RR. Cluster Analysis of Cardiovascular Phenotypes in Patients With Type 2 Diabetes and Established Atherosclerotic Cardiovascular Disease: A Potential Approach to Precision Medicine. Diabetes Care 2022; 45:204-212. [PMID: 34716214 PMCID: PMC9004312 DOI: 10.2337/dc20-2806] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 09/30/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Phenotypic heterogeneity among patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) is ill defined. We used cluster analysis machine-learning algorithms to identify phenotypes among trial participants with T2DM and ASCVD. RESEARCH DESIGN AND METHODS We used data from the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) study (n = 14,671), a cardiovascular outcome safety trial comparing sitagliptin with placebo in patients with T2DM and ASCVD (median follow-up 3.0 years). Cluster analysis using 40 baseline variables was conducted, with associations between clusters and the primary composite outcome (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina) assessed by Cox proportional hazards models. We replicated the results using the Exenatide Study of Cardiovascular Event Lowering (EXSCEL) trial. RESULTS Four distinct phenotypes were identified: cluster I included Caucasian men with a high prevalence of coronary artery disease; cluster II included Asian patients with a low BMI; cluster III included women with noncoronary ASCVD disease; and cluster IV included patients with heart failure and kidney dysfunction. The primary outcome occurred, respectively, in 11.6%, 8.6%, 10.3%, and 16.8% of patients in clusters I to IV. The crude difference in cardiovascular risk for the highest versus lowest risk cluster (cluster IV vs. II) was statistically significant (hazard ratio 2.74 [95% CI 2.29-3.29]). Similar phenotypes and outcomes were identified in EXSCEL. CONCLUSIONS In patients with T2DM and ASCVD, cluster analysis identified four clinically distinct groups. Further cardiovascular phenotyping is warranted to inform patient care and optimize clinical trial designs.
Collapse
Affiliation(s)
- Abhinav Sharma
- Division of Cardiology, McGill University, Montreal, Quebec, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Yinggan Zheng
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Justin A. Ezekowitz
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jacob A. Udell
- Peter Munk Cardiac Centre, University Health Network and Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shaun G. Goodman
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
- St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul W. Armstrong
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - John B. Buse
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer B. Green
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Robert G. Josse
- St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Darren K. McGuire
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Lee-Ming Chuang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Renato D. Lopes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Eric D. Peterson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Rury R. Holman
- Radcliffe Department of Medicine, University of Oxford, Oxford, U.K
| |
Collapse
|
5
|
Sharma A, Greene S, Vaduganathan M, Fudim M, Ambrosy AP, Sun J, McNulty SE, Hernandez AF, Borlaug BA, Velazquez EJ, Mentz RJ, DeVore AD, Alhanti B, Margulies K, Felker GM. Growth differentiation factor-15, treatment with liraglutide, and clinical outcomes among patients with heart failure. ESC Heart Fail 2021; 8:2608-2616. [PMID: 34061470 PMCID: PMC8318489 DOI: 10.1002/ehf2.13348] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/08/2021] [Accepted: 03/26/2021] [Indexed: 12/21/2022] Open
Abstract
AIMS Associations between growth differentiation factor-15 (GDF-15), cardiovascular outcomes, and exercise capacity among patients with a recent hospitalization for heart failure (HHF) and heart failure with reduced ejection fraction (HFrEF) are unknown. We utilized data from the 'Functional Impact of GLP-1 for Heart Failure Treatment' (FIGHT) study to address these knowledge gaps. METHODS AND RESULTS FIGHT was a randomized clinical trial testing the effect of liraglutide (vs. placebo) among 300 participants with HFrEF and a recent HHF. Multivariable regression models evaluated associations between baseline GDF-15 and change in GDF-15 (per 1000 pg/mL increase from baseline to 30 days) with clinical outcomes (at 180 days) and declines in exercise capacity (6 min walk distance ≥ 45 m). At baseline (n = 249), median GDF-15 value was 3221 pg/mL (interquartile range 1938-5511 pg/mL). Participants in the highest tertile of baseline GDF-15 were more likely to be male and have more co-morbidities. After adjustment, an increase in GDF-15 over 30 days was associated with higher risk of death or HHF [hazard ratio 1.35, 95% confidence interval (CI) 1.11-1.64]. In addition, higher baseline GDF-15 (per 1000 pg/mL until 6000 pg/mL) and an increase in GDF-15 over 30 days were associated with declining 6 min walk distance (odds ratio 1.26, 95% CI 1.02-1.55 and odds ratio 1.37, 95% CI 1.12-1.69, respectively). GDF-15 levels remained stable among participants randomized to liraglutide. CONCLUSIONS An increase in GDF-15 over 30 days among patients in HFrEF was independently associated with an increased risk of cardiovascular events and declining exercise capacity. These results support the value of longitudinal GDF-15 trajectory in informing risk of heart failure disease progression.
Collapse
Affiliation(s)
- Abhinav Sharma
- DREAM‐CV Lab, McGill University Health CentreMcGill UniversityMontrealQuebecCanada
| | - Stephen Greene
- Duke Clinical Research InstituteDuke University200 Morris StreetDurhamNC27701USA
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular CenterHarvard Medical SchoolBostonMAUSA
| | - Marat Fudim
- DREAM‐CV Lab, McGill University Health CentreMcGill UniversityMontrealQuebecCanada
| | | | - Jie‐Lena Sun
- Duke Clinical Research InstituteDuke University200 Morris StreetDurhamNC27701USA
| | - Steven E. McNulty
- Duke Clinical Research InstituteDuke University200 Morris StreetDurhamNC27701USA
| | - Adrian F. Hernandez
- Duke Clinical Research InstituteDuke University200 Morris StreetDurhamNC27701USA
| | | | - Eric J. Velazquez
- Cardiovascular Medicine, Department of Internal MedicineYale University School of MedicineNew HavenCTUSA
| | - Robert J. Mentz
- Duke Clinical Research InstituteDuke University200 Morris StreetDurhamNC27701USA
| | - Adam D. DeVore
- Duke Clinical Research InstituteDuke University200 Morris StreetDurhamNC27701USA
| | - Brooke Alhanti
- Duke Clinical Research InstituteDuke University200 Morris StreetDurhamNC27701USA
| | | | - G. Michael Felker
- Duke Clinical Research InstituteDuke University200 Morris StreetDurhamNC27701USA
| |
Collapse
|
6
|
Elharram M, Ferreira JP, Huynh T, Ni J, Giannetti N, Verma S, Zannad F, Sharma A. Prediction of heart failure outcomes in patients with type 2 diabetes mellitus: Validation of the Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (TRS-HF DM ) in patients in the ACCORD trial. Diabetes Obes Metab 2021; 23:782-790. [PMID: 33269511 DOI: 10.1111/dom.14283] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/17/2020] [Accepted: 11/28/2020] [Indexed: 12/17/2022]
Abstract
AIM To investigate the ability of the Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (TRS-HFDM ) to stratify patients with type 2 diabetes mellitus (T2DM) and high cardiovascular risk for heart failure (HF) hospitalization. MATERIALS AND METHODS We used data from the control group of the Action to Control Cardiovascular Risk in Diabetes Study Group (ACCORD) trial (n = 5123; mean follow-up 4.8 years). The TRS-HFDM includes: prior HF (2 points), atrial fibrillation (1 point), coronary artery disease (1 point), estimated glomerular filtration rate <60 mL/min/1.73 m2 (1 point), and urine albumin-to-creatinine ratio (>300 mg/g: 2 points; 30-300 mg/g: 1 point). We evaluated the discrimination (Harrell's C-index) and calibration (Nam-D'Agostino calibration statistic) of the TRS-HFDM with regard to time to HF hospitalization or death due to HF. RESULTS The mean age of the participants was 62.8 ± 6.6 years, and 38% were women. The prevalences of TRS-HFDM 0, 1, 2, 3 and ≥4 were 42.1%, 34.9%, 14.6%, 6.0% and 2.5%, respectively. Increasing TRS-HFDM corresponded to an increasing HF risk: 1.3 per 1000 person-years for a TRS-HFDM of 0 to 64.7 per 1000 person-years for TRS-HFDM of ≥4. The TRS-HFDM demonstrated robust discrimination of HF outcomes (C-index 0.78). Furthermore, the score was well calibrated for HF outcomes (calibration statistic P = 0.13). Similar results were seen in participants without baseline HF (C-index 0.75). CONCLUSION The TRS-HFDM discriminates HF-specific risk among people with T2DM. The use of TRS-HFDM to identify those who would maximally benefit from therapies that reduce HF risk warrants evaluation.
Collapse
Affiliation(s)
- Malik Elharram
- Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - João Pedro Ferreira
- Université de Lorraine, Centre D'Investigation Clinique- Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Hopitaux de Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Thao Huynh
- Montreal General Hospital, Montreal, Quebec, Canada
| | - Jiayi Ni
- Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
- Montreal General Hospital, Montreal, Quebec, Canada
| | - Nadia Giannetti
- Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Faiez Zannad
- Université de Lorraine, Centre D'Investigation Clinique- Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Hopitaux de Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Abhinav Sharma
- Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
- DREAM-CV Lab, McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
7
|
Renoprotective effects of sodium-glucose cotransporter-2 inhibitors and underlying mechanisms. Curr Opin Nephrol Hypertens 2021; 29:112-118. [PMID: 31725011 DOI: 10.1097/mnh.0000000000000561] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW Emerging data have demonstrated that sodium-glucose cotransporter-2 (SGLT2) inhibitors prevent cardiovascular events, especially heart failure-associated endpoints. Cardiovascular outcome trials have also suggested their renoprotective effects. One large clinical trial investigated renal primary endpoints and demonstrated that SGLT2 inhibitors slowed the progression of diabetic kidney disease (DKD). This review summarizes clinical trial data on renal outcomes and discusses potential underlying mechanisms. RECENT FINDINGS The EMPA-REG, CANVAS, and DECLARE-TIMI 58 studies revealed that SGLT2 inhibitors reduce the risk of cardiovascular events and concomitantly suggested that these drugs slow the progression of kidney disease in type 2 diabetes. The CREDENCE trial on patients with high-risk type 2 diabetes and chronic kidney disease demonstrated that canagliflozin treatment reduced the relative risk of a composite outcome, including end-stage kidney disease, serum creatinine doubling, and renal/cardiovascular death, by 30% in these patients. Animal experiments revealed that oxidative stress, inflammation, fibrosis, and tubuloglomerular feedback are underlying renoprotective mechanisms behind SGLT2 inhibitors. SUMMARY Recent clinical trials have established the renoprotective effects of SGLT2 inhibitors. Further investigations on mechanisms of these renoprotective effects will provide deeper insights and understanding of pathogenetic properties of DKD.
Collapse
|
8
|
Mak D, Ryan KA, Han JC. Review of Insulin Resistance in Dilated Cardiomyopathy and Implications for the Pediatric Patient Short Title: Insulin Resistance DCM and Pediatrics. Front Pediatr 2021; 9:756593. [PMID: 34778146 PMCID: PMC8581153 DOI: 10.3389/fped.2021.756593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/04/2021] [Indexed: 01/07/2023] Open
Abstract
Energy metabolism in the heart is affected during states of dysfunction. Understanding how the heart utilizes substrates in cardiomyopathy may be key to the development of alternative treatment modalities. Myocardial insulin resistance has been proposed as a possible barrier to effective glucose metabolism in the heart. Extensive literature on the topic in adult individuals exists; however, review in the pediatric population is sparse. The pathophysiology of disease in children and adolescents is unique. The aim of this paper is to review the current knowledge on insulin resistance in dilated cardiomyopathy while also filling the gap when considering care in the pediatric population.
Collapse
Affiliation(s)
- Daniel Mak
- Division of Pediatric Endocrinology, Department of Pediatrics, The University of Tennessee Health Sciences Center, Memphis, TN, United States
| | - Kaitlin A Ryan
- Division of Pediatric Cardiology, Department of Pediatrics, The University of Tennessee Health Sciences Center, Memphis, TN, United States
| | - Joan C Han
- Division of Pediatric Endocrinology, Department of Pediatrics, The University of Tennessee Health Sciences Center, Memphis, TN, United States
| |
Collapse
|
9
|
Araki E, Tanaka A, Inagaki N, Ito H, Ueki K, Murohara T, Imai K, Sata M, Sugiyama T, Ishii H, Yamane S, Kadowaki T, Komuro I, Node K. Diagnosis, prevention, and treatment of cardiovascular diseases in people with type 2 diabetes and prediabetes: a consensus statement jointly from the Japanese Circulation Society and the Japan Diabetes Society. Diabetol Int 2021; 12:1-51. [PMID: 33479578 PMCID: PMC7790968 DOI: 10.1007/s13340-020-00471-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Eiichi Araki
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501 Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kohjiro Ueki
- Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenjiro Imai
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School, Tokushima, Japan
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hideki Ishii
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Shunsuke Yamane
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501 Japan
| |
Collapse
|
10
|
Araki E, Tanaka A, Inagaki N, Ito H, Ueki K, Murohara T, Imai K, Sata M, Sugiyama T, Ishii H, Yamane S, Kadowaki T, Komuro I, Node K. Diagnosis, Prevention, and Treatment of Cardiovascular Diseases in People With Type 2 Diabetes and Prediabetes - A Consensus Statement Jointly From the Japanese Circulation Society and the Japan Diabetes Society. Circ J 2020; 85:82-125. [PMID: 33250455 DOI: 10.1253/circj.cj-20-0865] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Eiichi Araki
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University
| | | | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kohjiro Ueki
- Diabetes Research Center, Research Institute, National Center for Global Health and Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kenjiro Imai
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine
| | - Hideki Ishii
- Department of Cardiology, Fujita Health University Bantane Hospital
| | - Shunsuke Yamane
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine
| | | | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | | |
Collapse
|
11
|
Rogers FJ, Saghir Z. A Stepwise Approach to the Management of Heart Failure and its Comorbidities. J Osteopath Med 2020; 120:90-99. [PMID: 31985768 DOI: 10.7556/jaoa.2020.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Modern medical and technological advances provide highly effective management for the treatment of patients with heart failure with reduced ejection fraction (HFrEF). In this review, the authors propose a 2-step approach to treatment that is straightforward, practical, and thorough. For the patient whose life now includes HFrEF, the physician's first step is to ensure that the patient is taking the 3 key medications ([1] renin-angiotensin inhibitors (angiotensin receptor/neprilysin inhibitors, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers), [2] β-blockers, and [3] mineralocorticoid receptor antagonists) recommended in guideline-directed doses to attain comprehensive receptor blockade. Significant coexisting medical issues are also characteristic in patients with HFrEF. Therefore, the physician's second step is to address the comorbidities of heart failure to fulfill comprehensive patient care. This review presents evidence to implement the management of HFrEF and heart failure comorbidities that will reduce cardiac mortality and hospitalization and to avoid treatments that are of no benefit or may cause harm.
Collapse
|
12
|
Ferreira JP, Sharma A, Mehta C, Bakris G, Rossignol P, White WB, Zannad F. Multi-proteomic approach to predict specific cardiovascular events in patients with diabetes and myocardial infarction: findings from the EXAMINE trial. Clin Res Cardiol 2020; 110:1006-1019. [DOI: 10.1007/s00392-020-01729-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
|
13
|
Sharma A, Wu J, Xu H, Hernandez A, Felker GM, Al‐Khatib S, Green J, Matsouaka R, Fonarow GC, Singh JP, Heidenreich PA, Ezekowitz JA, DeVore A. Comparative Effectiveness of Primary Prevention Implantable Cardioverter-Defibrillators in Older Heart Failure Patients With Diabetes Mellitus. J Am Heart Assoc 2020; 9:e012405. [PMID: 32476539 PMCID: PMC7429066 DOI: 10.1161/jaha.119.012405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 12/04/2019] [Indexed: 01/02/2023]
Abstract
Background There are conflicting data regarding the benefit of primary prevention implantable cardioverter-defibrillators (ICDs) in patients with diabetes mellitus and heart failure (HF) with reduced ejection fraction. We aimed to assess the comparative effectiveness of ICD placement in patients with diabetes mellitus and HF with reduced ejection fraction. Methods and Results Data were obtained from the Get With the Guidelines-Health Failure registry, linked with claims from the Centers for Medicare & Medicaid Services. We used a Cox proportional hazards model censored at 5 years with propensity score matching. Of the 17 186 patients with HF with reduced ejection fraction from the Centers for Medicare & Medicaid Services claims database (6540 with diabetes mellitus; 38%), 1677 (646 with diabetes mellitus; 39%) received an ICD during their index HF hospitalization or were prescribed an ICD at discharge. Patients with diabetes mellitus and an ICD (n=646), as compared with those without an ICD (n=1031), were more likely to be younger (74 versus 78 years of age) and have coronary artery disease (68% versus 60%). After propensity matching, ICD use among patients with diabetes mellitus, as compared with those without an ICD, was associated with a reduced risk of all-cause mortality at 5 years after HF discharge (54% versus 59%; multivariable hazard ratio, 0.73; 95% CI, 0.64-0.82; P<0.0001). Ischemic heart disease did not modify the association between ICD use and all-cause mortality (P=0.95 for interaction). Similar results were seen in patients without diabetes mellitus. Conclusions Primary prevention ICD use among older patients with HF with reduced ejection fraction and diabetes mellitus was associated with a reduced risk of all-cause mortality. Our analysis supports current guideline recommendations for implantation of primary prevention ICDs among older patients with diabetes mellitus and HF with reduced ejection fraction.
Collapse
Affiliation(s)
- Abhinav Sharma
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNC
- McGill University Health CentreMontrealQuebecCanada
| | - Jingjing Wu
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNC
| | - Haolin Xu
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNC
| | - Adrian Hernandez
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNC
| | - G. Michael Felker
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNC
| | - Sana Al‐Khatib
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNC
| | - Jennifer Green
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNC
| | - Roland Matsouaka
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNC
| | | | | | | | - Justin A. Ezekowitz
- Faculty of Medicine and Dentistry, Canadian VIGOUR CenterUniversity of AlbertaEdmontonAlbertaCanada
| | - Adam DeVore
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNC
| |
Collapse
|
14
|
Abstract
Purpose of review Although type 2 diabetes (T2D) is one of the most important risk factors that leads to the development of de novo heart failure, there are limited data, particularly from a practical/qualitative standpoint, about predictors of heart failure in this population. Recent findings Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have been shown to prevent the development of heart failure and the composite of heart failure and cardiovascular death in patients with T2D without known heart failure who have either established atherosclerotic vascular disease or multiple risk factors. The concept of primary prevention of heart failure has led many clinicians to inquire if there are specific risk/enrichment factors that may predict an increased risk of heart failure. Summary In this review, we identify some general and diabetes-specific risk factors that are associated with an increased risk of developing heart failure in people with T2D.
Collapse
|
15
|
Sharma A, Pagidipati NJ, Califf RM, McGuire DK, Green JB, Demets D, George JT, Gerstein HC, Hobbs T, Holman RR, Lawson FC, Leiter LA, Pfeffer MA, Reusch J, Riesmeyer JS, Roe MT, Rosenberg Y, Temple R, Wiviott S, McMurray J, Granger C. Impact of Regulatory Guidance on Evaluating Cardiovascular Risk of New Glucose-Lowering Therapies to Treat Type 2 Diabetes Mellitus: Lessons Learned and Future Directions. Circulation 2020; 141:843-862. [PMID: 31992065 DOI: 10.1161/circulationaha.119.041022] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Responding to concerns about the potential for increased risk of adverse cardiovascular outcomes, specifically myocardial infarction, associated with certain glucose-lowering therapies, the US Food and Drug Administration and the Committee for Medicinal Products for Human Use of the European Medicines Agency issued guidance to the pharmaceutical industry in 2008. Glucose-lowering therapies were granted regulatory approval primarily from smaller studies that have demonstrated reductions in glycated hemoglobin concentration. Such studies were overall underpowered and of insufficient duration to show any effect on cardiovascular outcomes. The 2008 guidance aimed to ensure the cardiovascular safety of new glucose-lowering therapies to treat patients with type 2 diabetes mellitus. This resulted in a plethora of new cardiovascular outcome trials, most designed primarily as placebo-controlled noninferiority trials, but with many also powered for superiority. Several of these outcome trials demonstrated cardiovascular benefits of the newer agents, resulting in the first-ever cardiovascular protection indications for glucose-lowering therapies. Determining whether the guidance continues to have value in its current form is critically important as we move forward after the first decade of implementation. In February 2018, a think tank comprising representatives from academia, industry, and regulatory agencies convened to consider the guidance in light of the findings of the completed cardiovascular outcome trials. The group made several recommendations for future regulatory guidance and for cardiovascular outcome trials of glucose-lowering therapies. These recommendations include requiring only the 1.3 noninferiority margin for regulatory approval, conducting trials for longer durations, considering studying glucose-lowering therapies as first-line management of type 2 diabetes mellitus, considering heart failure or kidney outcomes within the primary outcome, considering head-to-head active comparator trials, increasing the diversity of patients enrolled, evaluating strategies to streamline registries and the study of unselected populations, and identifying ways to improve translation of trial results to general practice.
Collapse
Affiliation(s)
- Abhinav Sharma
- Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada (A.S.).,Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (A.S.)
| | - Neha J Pagidipati
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (N.J.P., J.B.G., M.T.R., C.G.)
| | - Robert M Califf
- Verily Life Sciences and Duke University School of Medicine, Durham, NC (R.M.C.)
| | | | - Jennifer B Green
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (N.J.P., J.B.G., M.T.R., C.G.)
| | | | | | | | | | - Rury R Holman
- Diabetes Trials Unit, University of Oxford, UK (R.R.H.)
| | | | | | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.)
| | - Jane Reusch
- University of Colorado School of Medicine, Denver (J.R.)
| | | | - Matthew T Roe
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (N.J.P., J.B.G., M.T.R., C.G.)
| | - Yves Rosenberg
- National Heart, Lung, and Blood Institute, Bethesda, MD (Y.R.)
| | - Robert Temple
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD (R.T.)
| | | | | | - Christopher Granger
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (N.J.P., J.B.G., M.T.R., C.G.)
| |
Collapse
|
16
|
Sharma A, Vaduganathan M, Ferreira JP, Liu Y, Bakris GL, Cannon CP, White WB, Zannad F. Clinical and Biomarker Predictors of Expanded Heart Failure Outcomes in Patients With Type 2 Diabetes Mellitus After a Recent Acute Coronary Syndrome: Insights From the EXAMINE Trial. J Am Heart Assoc 2020; 9:e012797. [PMID: 31902327 PMCID: PMC6988143 DOI: 10.1161/jaha.119.012797] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/26/2019] [Indexed: 12/13/2022]
Abstract
Background Improved heart failure (HF) risk stratification after a recent acute coronary syndrome may identify those who can benefit from therapies that reduce HF risk. We aimed to identify clinical and biomarker predictors for expanded HF outcomes in patients with type 2 diabetes mellitus after recent acute coronary syndrome. Methods and Results The EXAMINE (Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care) trial was a multicenter, non-inferiority, double-masked, placebo-controlled study which randomized 5380 patients with type 2 diabetes mellitus after recent acute coronary syndrome to alogliptin or placebo. Baseline biomarkers were measured in 5154 patients: NT-proBNP (N-terminal pro-B-type natriuretic peptide), high-sensitivity troponin I, adiponectin, growth-differentiation-factor-15, and galectin-3. Our primary outcome was cardiovascular) death, HF hospitalization, elevated NT-proBNP during follow-up, or loop diuretics initiation. The association between clinical variables, biomarkers, and outcomes were assessed using Cox regression models. In the study population, the median age was 61.0 years, 67.7% were men, and 28.0% had baseline HF (median follow-up was 18 months). In multivariable analyses, NT-proBNP had the strongest association with the primary outcome (per log2, hazard ratio 1.24; Wald χ2 67.4; P<0.0001) followed by a prior HF history (hazard ratio 1.42; Wald χ2 20.8; P<0.0001). A model with clinical variables and biomarkers allowed for risk prediction for expanded HF outcomes (C-statistic=0.72). Discrimination results were similar for cardiovascular death or HF hospitalization. Conclusions Among patients with type 2 diabetes mellitus after recent acute coronary syndrome, the use biomarkers such as N-terminal pro-B-type natriuretic peptide and clinical variables enables risk stratification for expanded HF outcomes. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00968708.
Collapse
Affiliation(s)
- Abhinav Sharma
- INSERM CIC 1433NI‐CRCT (Cardiovascular and Renal Clinical Trialists) F‐CRIN networkUniversité de Lorraine and CHRUNancyFrance
- Division of CardiologyStanford UniversityPalo AltoCA
- Division of CardiologyMcGill UniversityMontrealQCCanada
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular CenterHarvard Medical School BostonMA
| | - João Pedro Ferreira
- INSERM CIC 1433NI‐CRCT (Cardiovascular and Renal Clinical Trialists) F‐CRIN networkUniversité de Lorraine and CHRUNancyFrance
- Department of PhysiologyUniversity of PortoPortugal
| | - Yuyin Liu
- Baim Institute for Clinical ResearchBostonMA
| | | | | | | | - Faiez Zannad
- INSERM CIC 1433NI‐CRCT (Cardiovascular and Renal Clinical Trialists) F‐CRIN networkUniversité de Lorraine and CHRUNancyFrance
| |
Collapse
|
17
|
Raparelli V, Elharram M, Moura CS, Abrahamowicz M, Bernatsky S, Behlouli H, Pilote L. Sex Differences in Cardiovascular Effectiveness of Newer Glucose-Lowering Drugs Added to Metformin in Type 2 Diabetes Mellitus. J Am Heart Assoc 2020; 9:e012940. [PMID: 31902326 PMCID: PMC6988160 DOI: 10.1161/jaha.119.012940] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Randomized controlled trials showed that newer glucose‐lowering agents are cardioprotective, but most participants were men. It is unknown whether benefits are similar in women. Methods and Results Among adults with type 2 diabetes mellitus not controlled with metformin with no prior use of insulin, we assessed for sex differences in the cardiovascular effectiveness and safety of sodium‐glucose‐like transport‐2 inhibitors (SGLT‐2i), glucagon‐like peptide‐1 receptor agonists (GLP‐1RA), dipeptidyl peptidase‐4 inhibitors, initiated as second‐line agents relative to sulfonylureas (reference‐group). We studied type 2 diabetes mellitus American adults with newly dispensed sulfonylureas, SGLT‐2i, GLP‐1RA, or dipeptidyl peptidase‐4 inhibitors (Marketscan‐Database: 2011–2017). We used multivariable Cox proportional hazards models with time‐varying exposure to compare time to first nonfatal cardiovascular event (myocardial infarction/unstable angina, stroke, and heart failure), and safety outcomes between drugs users, and tested for sex–drug interactions. Among 167 254 type 2 diabetes mellitus metformin users (46% women, median age 59 years, at low cardiovascular risk), during a median 4.5‐year follow‐up, cardiovascular events incidence was lower in women than men (14.7 versus 16.7 per 1000‐person‐year). Compared with sulfonylureas, hazard ratios (HRs) for cardiovascular events were lower with GLP‐1RA (adjusted HR‐women: 0.57, 95% CI: 0.48–0.68; aHR‐men: 0.82, 0.71–0.95), dipeptidyl peptidase‐4 inhibitors (aHR‐women: 0.83, 0.77–0.89; aHR‐men: 0.85, 0.79–0.91) and SGLT‐2i (aHR‐women: 0.58, 0.46–0.74; aHR‐men: 0.69, 0.57–0.83). A sex‐by‐drug interaction was statistically significant only for GLP‐1RA (P=0.002), suggesting greater cardiovascular effectiveness in women. Compared with sulfonylureas, risks of adverse events were similarly lower in both sexes for GLP‐1RA (aHR‐women: 0.81, 0.73–0.89; aHR‐men: 0.80, 0.71–0.89), dipeptidyl peptidase‐4 inhibitors (aHR‐women: 0.82, 0.78–0.87; aHR‐men: 0.83, 0.78–0.87) and SGLT‐2i (aHR‐women: 0.68, 0.59–0.78; aHR‐men: 0.67, 0.59–0.78) (all sex–drug interactions for adverse events P>0.05). Conclusions Newer glucose‐lowering drugs were associated with lower risk of cardiovascular events than sulfonylureas, with greater effectiveness of GLP‐1RA in women than men. Overall, they appeared safe, with a better safety profile for SGLT‐2i than for GLP‐1RA regardless of sex.
Collapse
Affiliation(s)
- Valeria Raparelli
- Department of Experimental Medicine Sapienza University of Rome Italy.,Department of Medicine McGill University Montreal QC Canada.,Research Institute McGill University Health Centre Montreal QC Canada
| | - Malik Elharram
- Department of Medicine McGill University Montreal QC Canada.,Division of Experimental Medicine McGill University Montreal QC Canada
| | - Cristiano S Moura
- Research Institute McGill University Health Centre Montreal QC Canada
| | - Michal Abrahamowicz
- Research Institute McGill University Health Centre Montreal QC Canada.,Department of Epidemiology, Biostatistics and Occupational Health McGill University Montreal QC Canada
| | - Sasha Bernatsky
- Department of Medicine McGill University Montreal QC Canada.,Research Institute McGill University Health Centre Montreal QC Canada.,Department of Epidemiology, Biostatistics and Occupational Health McGill University Montreal QC Canada
| | - Hassan Behlouli
- Research Institute McGill University Health Centre Montreal QC Canada
| | - Louise Pilote
- Department of Medicine McGill University Montreal QC Canada.,Research Institute McGill University Health Centre Montreal QC Canada.,Division of Experimental Medicine McGill University Montreal QC Canada.,Department of Epidemiology, Biostatistics and Occupational Health McGill University Montreal QC Canada
| |
Collapse
|
18
|
Khan MS, Butler J. Sodium-Glucose Cotransporter-2 Inhibitors and Heart Failure Prevention in Type 2 Diabetes. Card Fail Rev 2019; 5:169-172. [PMID: 31768274 PMCID: PMC6848945 DOI: 10.15420/cfr.2019.06.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/21/2019] [Indexed: 12/14/2022] Open
Abstract
Diabetes and heart failure (HF) are closely linked, with one causing a worse prognosis in the other. The majority of anti-hyperglycaemic agents primarily reduce risk of ischaemic microvascular events without targeting the mechanisms involved for diabetes cardiomyopathy and HF. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have emerged as a novel class of glucose-lowering agents that have consistently reduced HF hospitalisations, unlike other agents. The authors discuss the current evidence and highlight possible future directions for the role of SGLT2 inhibitors in HF prevention.
Collapse
Affiliation(s)
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson Mississippi, US
| |
Collapse
|
19
|
Sharma A, Verma S. Mechanisms by Which Glucagon-Like-Peptide-1 Receptor Agonists and Sodium-Glucose Cotransporter-2 Inhibitors Reduce Cardiovascular Risk in Adults With Type 2 Diabetes Mellitus. Can J Diabetes 2019; 44:93-102. [PMID: 31882322 DOI: 10.1016/j.jcjd.2019.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 02/06/2023]
Abstract
The growing global burden of type 2 diabetes mellitus confers significant morbidity and mortality in addition to significant cost to local health-care systems. In recent years, 2 classes of therapies have shown some promise in reducing the risk of adverse cardiovascular (CV) events: 1) glucagon-like-peptide-1 (GLP-1) receptor agonists and 2) sodium-glucose cotransporter-2 (SGLT-2) inhibitors. The mechanisms whereby these therapies reduce the risk of adverse CV outcomes are emerging. Both classes of therapies have overlapping yet distinct mechanisms of action. GLP-1 receptor agonists appear to target the incretin axis, inhibit gastric mobility pathways, modify CV risk factors through weight reduction, induce protection of ischemia/reperfusion injury and improve endothelial dysfunction. In comparison, SGLT-2 inhibitors appear to improve ventricular loading conditions, reduce sympathetic nervous system activation, reduce cardiac fibrosis, reduce renal hypoxia and renal-cardiac signalling, reduce left ventricular mass and improve cardiac energetics. In this review, we summarize the potential mechanisms whereby GLP-1 receptor agonists and SGLT-2 inhibitors improve CV outcomes in patients with type 2 diabetes and highlight evidence for their use in populations without diabetes.
Collapse
Affiliation(s)
- Abhinav Sharma
- Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
20
|
Sharma A, Mentz RJ, Granger BB, Heitner JF, Cooper LB, Banerjee D, Green CL, Majumdar MD, Eapen Z, Hudson L, Felker GM. Utilizing mobile technologies to improve physical activity and medication adherence in patients with heart failure and diabetes mellitus: Rationale and design of the TARGET-HF-DM Trial. Am Heart J 2019; 211:22-33. [PMID: 30831331 DOI: 10.1016/j.ahj.2019.01.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 01/25/2019] [Indexed: 12/25/2022]
Abstract
Heart failure (HF) and diabetes mellitus (DM) are major public health issues that place significant burden on patients and health care systems. Patients with both HF and DM are at higher risk of adverse cardiovascular and HF outcomes than those with either disease in isolation. Different antihyperglycemic medications (even within the same medication class) have conflicting results of benefit or harm in patients with established and incident HF. Recent data highlight the importance of a renewed focus on optimal pharmacotherapy for this population with DM and HF (or at risk for HF). Both HF and DM require major lifestyle modification for optimal management, in terms of both optimizing health behaviors (eg, physical activity, diet) and adherence to complex medical and self-care regimens. Mobile health (mHealth) technologies (eg, apps, wearables) are widely available in the community and may play a role in optimizing the health status of patients; however, there is limited and conflicting information on whether such technologies are actually beneficial in at-risk populations. In this article, we summarize current strategies, including mobile health interventions, to improve physical activity levels, drug adherence, and outcomes in patients with DM, HF, or both and describe the design and rationale for the Technologies to improve drug Adherence and Reinforce Guideline based Exercise Targets in patients with heart Failure and Diabetes Mellitus trial, which is designed to test the efficacy of using mHealth technology to improve health behaviors and outcomes in this high-risk population.
Collapse
Affiliation(s)
- Abhinav Sharma
- Division of Cardiology, Stanford University, Palo Alto, CA; Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - John F Heitner
- Division of Cardiology, Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, New York, NY
| | | | | | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Maulik D Majumdar
- Healthcare Transformation Lab, Massachusetts General Hospital, Boston, MA
| | | | - Lori Hudson
- Duke Clinical Research Institute, Durham, NC
| | | |
Collapse
|