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Hu L, Qian L, Sun A, Cai G, Gao Y, Yuan Y, Chen X, Jiang Y, Liu J, Ren J. Efficacy of traditional Chinese medicine on diabetic cardiomyopathy in animal models: a systematic review and meta-analysis. Front Pharmacol 2023; 14:1253572. [PMID: 37849730 PMCID: PMC10578493 DOI: 10.3389/fphar.2023.1253572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Abstract
Background: Diabetic cardiomyopathy (DCM) is a severe complication of diabetes that can diminish the quality of life in patients and is a leading cause of death. Research has demonstrated the effectiveness of Traditional Chinese Medicine (TCM) in reducing blood sugar levels and protecting cardiovascular function in both animal models and clinical research studies. Nevertheless, the efficacy of TCM in animal models of DCM has not been analyzed systematically. Method: We searched the following electronic bibliographic databases: Web of Science, PubMed, Cochrane Library, and CNKI(China National Knowledge Infrastructure). Studies that reported the efficacy of TCM in animals with DCM were included. The literature search was conducted using the terms. The data will be restricted from the year 2013 to 24 April 2023, 24 studies were included in the meta-analysis. Result: A total of 24 Traditional Chinese Medicine interventions and 2157 animals met the inclusion criteria. The pooled data revealed that TCM interventions resulted in significant improvements in body weight (BW), heart weight (HW) to body weight ratio (HW/BW), triglyceride (TG) and cholesterol (TC) levels, ejection fraction (EF), fractional shortening (FS) and E/A ratio. Subgroup analysis and meta-regression revealed that the type of TCM, duration of intervention, method of modeling, and animal species were potential sources of heterogeneity. Conclusion: TCM interventions were associated with significant improvements in body weight, heart weight to body weight ratio, triglyceride and cholesterol levels, left ventricular internal dimension in systole, ejection fraction, fractional shortening and E/A ratio. The heterogeneity in the results was found to be potentially due to the type of TCM, duration of intervention, method of modeling, and animal species, as shown in subgroup analysis and meta-regression. Systematic Review Registration: identifier CRD42023402908.
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Affiliation(s)
- Longxiao Hu
- Xiyuan Hospital, Institute of Basic Medical Sciences, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Longxin Qian
- Xiyuan Hospital, Institute of Basic Medical Sciences, China Academy of Chinese Medical Sciences, Beijing, China
| | - Aochuan Sun
- Xiyuan Hospital, Institute of Basic Medical Sciences, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Guida Cai
- Institute of Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yunxiao Gao
- Xiyuan Hospital, Institute of Basic Medical Sciences, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yue Yuan
- Xiyuan Hospital, Institute of Basic Medical Sciences, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaoxiao Chen
- Xiyuan Hospital, Institute of Basic Medical Sciences, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yunyao Jiang
- Institute for Chinese Materia Medica, School of Pharmaceutical Sciences, Tsinghua University, Beijing, China
| | - Jianxun Liu
- Xiyuan Hospital, Institute of Basic Medical Sciences, China Academy of Chinese Medical Sciences, Beijing, China
| | - Junguo Ren
- Xiyuan Hospital, Institute of Basic Medical Sciences, China Academy of Chinese Medical Sciences, Beijing, China
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Chen SY, Kong XQ, Zhang KF, Luo S, Wang F, Zhang JJ. DPP4 as a Potential Candidate in Cardiovascular Disease. J Inflamm Res 2022; 15:5457-5469. [PMID: 36147690 PMCID: PMC9488155 DOI: 10.2147/jir.s380285] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/09/2022] [Indexed: 11/23/2022] Open
Abstract
The rising prevalence of cardiovascular disease has become a global health concern. The occurrence of cardiovascular disease is the result of long-term interaction of many risk factors, one of which is diabetes. As a novel anti-diabetic drug, DPP4 inhibitor has been proven to be cardiovascular safe in five recently completed cardiovascular outcome trials. Accumulating studies suggest that DPP4 inhibitor has potential benefits in a variety of cardiovascular diseases, including hypertension, calcified aortic valve disease, coronary atherosclerosis, and heart failure. On the one hand, in addition to improving blood glucose control, DPP4 inhibitor is involved in controlling cardiovascular risk factors. On the other hand, DPP4 inhibitor directly regulates the occurrence and progression of cardiovascular diseases through a variety of mechanisms. In this review, we summarize the recent advances of DPP4 in cardiovascular disease, aiming to discuss DPP4 inhibitor as a potential option for cardiovascular therapy.
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Affiliation(s)
- Si-Yu Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Xiang-Quan Kong
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China.,Department of Cardiology, Nanjing Heart Centre, Nanjing, People's Republic of China
| | - Ke-Fan Zhang
- Department of General Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Shuai Luo
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Feng Wang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Jun-Jie Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China.,Department of Cardiology, Nanjing Heart Centre, Nanjing, People's Republic of China
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Cardoso R, Graffunder FP, Ternes CM, Fernandes A, Rocha AV, Fernandes G, Bhatt DL. SGLT2 inhibitors decrease cardiovascular death and heart failure hospitalizations in patients with heart failure: A systematic review and meta-analysis. EClinicalMedicine 2021; 36:100933. [PMID: 34308311 PMCID: PMC8257984 DOI: 10.1016/j.eclinm.2021.100933] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the composite of heart failure (HF) hospitalizations or cardiovascular mortality among patients with HF. However, the efficacy of SGLT2 inhibitors in secondary endpoints of randomized trials and in subgroups of HF patients is not well known. METHODS We performed a systematic review and meta-analysis of placebo-controlled, randomized trials of SGLT2 inhibitors in patients with HF. PubMed, Embase, and Cochrane databases were searched for trials published up to January 21, 2021. Data were extracted from published reports and quality assessment was performed per Cochrane recommendations. Hazard ratios (HRs) with 95% CI were pooled across trials. The primary endpoints of interest were all-cause and cardiovascular mortality. RESULTS Out of 3969 database results, 15 randomized trials and 20,241 patients were included; 10,594 (52·3%) received SGLT2 inhibitors. All-cause mortality (HR 0·86; 95% CI 0·79-0·94; p = 0·0007; I2=0%) and cardiovascular mortality (HR 0·86; 95% CI 0·78-0·96; p = 0·006; I2=0%) were significantly lower in patients treated with SGLT2 inhibitors compared with placebo. The composite of cardiovascular mortality, HF hospitalizations, or urgent visits for HF was significantly reduced with SGLT2 inhibitors in all the following subgroups: male, female, age < 65, age ≥ 65, race - Black and White, estimated glomerular filtration rate (eGFR) <60, eGFR ≥60, New York Heart Association (NYHA) class II, NYHA ≥III, and HF with preserved ejection fraction. INTERPRETATION In patients with HF, SGLT2 inhibitors significantly reduce all-cause and cardiovascular mortality compared with placebo. In addition, the composite of cardiovascular mortality or HF hospitalizations/urgent visits is reduced with SGLT2 inhibitors across subgroups of sex, age, race, eGFR, HF functional class, and ejection fraction.
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Key Words
- DM, diabetes mellitus
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- HR, hazard ratio
- Heart failure
- LVEF, left ventricular ejection fraction
- NYHA, New York Heart Association
- OR, odds ratio
- RCTs, randomized controlled trials
- SGLT2 inhibitors
- SGLT2, sodium-glucose cotransporter 2
- Type 2 Diabetes
- cardiovascular risk
- eGFR, estimated glomerular filtration rate
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Affiliation(s)
- Rhanderson Cardoso
- Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Caique M.P. Ternes
- Division of Medicine, Federal University of Santa Catarina, Florianopolis, Brazil
- Cardiac Arrhythmia Service, SOS Cardio Hospital, Florianopolis, Brazil
| | | | - Ana V. Rocha
- Division of Medicine, Federal University of Goias, Goiania, Brazil
| | - Gilson Fernandes
- Division of Cardiology, University of Miami, Miami, United States
| | - Deepak L. Bhatt
- Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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Li L, Li G, Chen H, Feng Z, Zhang L, Chen L, Fan L. Role of Diabetes Mellitus in Acute Coronary Syndrome Patients with Heart Failure and Midrange Ejection Fraction Who Have Undergone Percutaneous Coronary Intervention: A 3-Year Case-Series Follow-Up Retrospective Study. Diabetes Metab Syndr Obes 2021; 14:4931-4944. [PMID: 35002266 PMCID: PMC8720864 DOI: 10.2147/dmso.s339209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/04/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Data are limited on the effect of diabetes mellitus (DM) on the prognosis of acute coronary syndrome (ACS) patients with heart failure with midrange ejection fraction (HFmrEF) who have undergone percutaneous coronary intervention (PCI). This study aimed to investigate the relationship between type 2 DM (T2DM) and 3-year outcomes in such a population. METHODS A total of 377 ACS patients with HFmrEF (left ventricular EF 40%-49%) who had undergone PCI (132 diabetic and 245 nondiabetic patients) were included in the analysis. The primary outcome was a composite end point of all-cause death or HF rehospitalization. Cox proportional-hazard regression analysis and Kaplan-Meier tests were used to assess the effect of DM on the primary outcome. Sensitivity analysis was conducted with propensity score-matching analysis. RESULTS During a follow-up of 3 years, diabetic patients had higher incidence of the primary outcome than nondiabetic patients (96.1 vs 44.6 per 1,000 patient-years, incidence ratio 2.301, 95% CI 1.334-3.969; P=0.002). Multivariate analysis showed that DM was associated with a significant increase in the composite outcome of all-cause death or HF rehospitalization (adjusted HR 2.080, 95% CI 1.115-3.878; P=0.021). Sensitivity analysis further confirmed that DM was an independent prognostic factor of long-term adverse outcomes for ACS patients with HFmrEF who had undergone PCI (adjusted HR 3.792, 95% CI 1.802-7.980; P<0.001). CONCLUSION Among ACS patients with HFmrEF who had undergone PCI, T2DM comorbidity was significantly associated with worse long-term outcomes.
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Affiliation(s)
- Lieyou Li
- Department of Cardiology, Fujian Medical University Union Hospital Institute of Coronary Heart Disease, Fuzhou, Fujian, People’s Republic of China
| | - Ganyang Li
- Department of Cardiology, Longyan First Hospital Affiliated with Fujian Medical University, Longyan, Fujian, People’s Republic of China
| | - Huang Chen
- Department of Cardiology, Fujian Medical University Union Hospital Institute of Coronary Heart Disease, Fuzhou, Fujian, People’s Republic of China
| | - Zhihai Feng
- Department of Cardiology, Fujian Medical University Union Hospital Institute of Coronary Heart Disease, Fuzhou, Fujian, People’s Republic of China
| | - Lin Zhang
- Department of Cardiology, Fujian Medical University Union Hospital Institute of Coronary Heart Disease, Fuzhou, Fujian, People’s Republic of China
| | - Lianglong Chen
- Department of Cardiology, Fujian Medical University Union Hospital Institute of Coronary Heart Disease, Fuzhou, Fujian, People’s Republic of China
| | - Lin Fan
- Department of Cardiology, Fujian Medical University Union Hospital Institute of Coronary Heart Disease, Fuzhou, Fujian, People’s Republic of China
- Correspondence: Lin Fan Tel +86 591 8335-7896Fax +86 591 83308713 Email
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Effects of empagliflozin and target-organ damage in a novel rodent model of heart failure induced by combined hypertension and diabetes. Sci Rep 2020; 10:14061. [PMID: 32820187 PMCID: PMC7441148 DOI: 10.1038/s41598-020-70708-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/23/2020] [Indexed: 01/24/2023] Open
Abstract
Type 2 diabetes mellitus and hypertension are two major risk factors leading to heart failure and cardiovascular damage. Lowering blood sugar by the sodium-glucose co-transporter 2 inhibitor empagliflozin provides cardiac protection. We established a new rat model that develops both inducible diabetes and genetic hypertension and investigated the effect of empagliflozin treatment to test the hypothesis if empagliflozin will be protective in a heart failure model which is not based on a primary vascular event. The transgenic Tet29 rat model for inducible diabetes was crossed with the mRen27 hypertensive rat to create a novel model for heart failure with two stressors. The diabetic, hypertensive heart failure rat (mRen27/tetO-shIR) were treated with empagliflozin (10 mg/kg/d) or vehicle for 4 weeks. Cardiovascular alterations were monitored by advanced speckle tracking echocardiography, gene expression analysis and immunohistological staining. The novel model with increased blood pressure und higher blood sugar levels had a reduced survival compared to controls. The rats develop heart failure with reduced ejection fraction. Empagliflozin lowered blood sugar levels compared to vehicle treated animals (182.3 ± 10.4 mg/dl vs. 359.4 ± 35.8 mg/dl) but not blood pressure (135.7 ± 10.3 mmHg vs. 128.2 ± 3.8 mmHg). The cardiac function was improved in all three global strains (global longitudinal strain - 8.5 ± 0.5% vs. - 5.5 ± 0.6%, global radial strain 20.4 ± 2.7% vs. 8.8 ± 1.1%, global circumferential strain - 11.0 ± 0.7% vs. - 7.6 ± 0.8%) and by increased ejection fraction (42.8 ± 4.0% vs. 28.2 ± 3.0%). In addition, infiltration of macrophages was decreased by treatment (22.4 ± 1.7 vs. 32.3 ± 2.3 per field of view), despite mortality was not improved. Empagliflozin showed beneficial effects on cardiovascular dysfunction. In this novel rat model of combined hypertension and diabetes, the improvement in systolic and diastolic function was not secondary to a reduction in left ventricular mass or through modulation of the afterload, since blood pressure was not changed. The mRen27/tetO-shIR strain should provide utility in separating blood sugar from blood pressure-related treatment effects.
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Athithan L, Gulsin GS, McCann GP, Levelt E. Diabetic cardiomyopathy: Pathophysiology, theories and evidence to date. World J Diabetes 2019; 10:490-510. [PMID: 31641426 PMCID: PMC6801309 DOI: 10.4239/wjd.v10.i10.490] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 02/05/2023] Open
Abstract
The prevalence of type 2 diabetes (T2D) has increased worldwide and doubled over the last two decades. It features among the top 10 causes of mortality and morbidity in the world. Cardiovascular disease is the leading cause of complications in diabetes and within this, heart failure has been shown to be the leading cause of emergency admissions in the United Kingdom. There are many hypotheses and well-evidenced mechanisms by which diabetic cardiomyopathy as an entity develops. This review aims to give an overview of these mechanisms, with particular emphasis on metabolic inflexibility. T2D is associated with inefficient substrate utilisation, an inability to increase glucose metabolism and dependence on fatty acid oxidation within the diabetic heart resulting in mitochondrial uncoupling, glucotoxicity, lipotoxicity and initially subclinical cardiac dysfunction and finally in overt heart failure. The review also gives a concise update on developments within clinical imaging, specifically cardiac magnetic resonance studies to characterise and phenotype early cardiac dysfunction in T2D. A better understanding of the pathophysiology involved provides a platform for targeted therapy in diabetes to prevent the development of early heart failure with preserved ejection fraction.
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Affiliation(s)
- Lavanya Athithan
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester LE3 9QP, United Kingdom
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester LE3 9QP, United Kingdom
| | - Gerald P McCann
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester LE3 9QP, United Kingdom
| | - Eylem Levelt
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LF9 7TF, United Kingdom
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Dogruel H, Balci MK. Development of therapeutic options on type 2 diabetes in years: Glucagon-like peptide-1 receptor agonist’s role intreatment; from the past to future. World J Diabetes 2019; 10:446-453. [PMID: 31523380 PMCID: PMC6715574 DOI: 10.4239/wjd.v10.i8.446] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/13/2019] [Accepted: 07/27/2019] [Indexed: 02/05/2023] Open
Abstract
Diabetes mellitus (DM) is a chronic metabolic disease characterized by hypergly-cemia. Type 2 diabetes (T2DM) accounting for 90% of cases globally. The worldwide prevalence of DM is rising dramatically over the last decades, from 30 million cases in 1985 to 382 million cases in 2013. It’s estimated that 451 million people had diabetes in 2017. As the pathophysiology was understood over the years, treatment options for diabetes increased. Incretin-based therapy is one of them. Glucagon-like peptide-1 receptor agonist (GLP-1 RA) not only significantly lower glucose level with minimal risk of hypoglycemia but also, they have an important advantage in themanagement of cardiovascular risk and obesity. Thus, we will review here GLP-1 RAsrole in the treatment of diabetes.
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Affiliation(s)
- Hakan Dogruel
- Department of Internal Medicine, Antalya Ataturk State Hospital, Antalya 07040, Turkey
| | - Mustafa Kemal Balci
- Akdeniz University Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Antalya 07070, Turkey
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Hershon KS, Hirsch BR, Odugbesan O. Importance of Postprandial Glucose in Relation to A1C and Cardiovascular Disease. Clin Diabetes 2019; 37:250-259. [PMID: 31371856 PMCID: PMC6640888 DOI: 10.2337/cd18-0040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IN BRIEF This article reviews the evidence regarding the impact of postprandial glucose (PPG) on overall A1C and its relation to cardiovascular disease (CVD). To date, four randomized, controlled trials have evaluated the impact of PPG reduction on CVD; however, only one of these successfully demonstrated a positive effect. Despite this, epidemiological evidence does indicate a cardiovascular benefit of PPG reduction, and agents that can be used to manage PPG in people with type 2 diabetes are also discussed.
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Affiliation(s)
| | | | - Ola Odugbesan
- North Atlanta Endocrinology and Diabetes, Lawrenceville, GA
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McMurray JJ, DeMets DL, Inzucchi SE, Køber L, Kosiborod MN, Langkilde AM, Martinez FA, Bengtsson O, Ponikowski P, Sabatine MS, Sjöstrand M, Solomon SD. A trial to evaluate the effect of the sodium-glucose co-transporter 2 inhibitor dapagliflozin on morbidity and mortality in patients with heart failure and reduced left ventricular ejection fraction (DAPA-HF). Eur J Heart Fail 2019; 21:665-675. [PMID: 30895697 PMCID: PMC6607736 DOI: 10.1002/ejhf.1432] [Citation(s) in RCA: 245] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/21/2018] [Accepted: 01/03/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been shown to reduce the risk of incident heart failure hospitalization in individuals with type 2 diabetes who have, or are at high risk of, cardiovascular disease. Most patients in these trials did not have heart failure at baseline and the effect of SGLT2 inhibitors on outcomes in individuals with established heart failure (with or without diabetes) is unknown. DESIGN AND METHODS The Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure trial (DAPA-HF) is an international, multicentre, parallel group, randomized, double-blind, study in patients with chronic heart failure, evaluating the effect of dapagliflozin 10 mg, compared with placebo, given once daily, in addition to standard care, on the primary composite outcome of a worsening heart failure event (hospitalization or equivalent event, i.e. an urgent heart failure visit) or cardiovascular death. Patients with and without diabetes are eligible and must have a left ventricular ejection fraction ≤ 40%, a moderately elevated N-terminal pro B-type natriuretic peptide level, and an estimated glomerular filtration rate ≥ 30 mL/min/1.73 m2 . The trial is event-driven, with a target of 844 primary outcomes. Secondary outcomes include the composite of total heart failure hospitalizations (including repeat episodes), and cardiovascular death and patient-reported outcomes. A total of 4744 patients have been randomized. CONCLUSIONS DAPA-HF will determine the efficacy and safety of the SGLT2 inhibitor dapagliflozin, added to conventional therapy, in a broad spectrum of patients with heart failure and reduced ejection fraction.
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Affiliation(s)
| | - David L. DeMets
- Department of Biostatistics and Medical Informatics, School of Medicine and Public HealthUniversity of WisconsinMadisonWIUSA
| | - Silvio E. Inzucchi
- Section of EndocrinologyYale University School of MedicineNew HavenCTUSA
| | - Lars Køber
- Rigshospitalet Copenhagen University HospitalCopenhagenDenmark
| | - Mikhail N. Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri‐Kansas CityKansas CityMOUSA
- The George Institute for Global HealthSydneyAustralia
| | | | | | | | | | - Marc S. Sabatine
- TIMI Study Group, Division of Cardiovascular MedicineBrigham and Women's Hospital, and Harvard Medical SchoolBostonMAUSA
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10
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Yang DY, He X, Liang HW, Zhang SZ, Zhong XB, Luo CF, Du ZM, He JG, Zhuang XD, Liao XX. Comparative outcomes of heart failure among existent classes of anti-diabetic agents: a network meta-analysis of 171,253 participants from 91 randomized controlled trials. Cardiovasc Diabetol 2019; 18:47. [PMID: 30961600 PMCID: PMC6454617 DOI: 10.1186/s12933-019-0853-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/02/2019] [Indexed: 12/25/2022] Open
Abstract
Background The cardiovascular (CV) safety in terms of heart failure among different classes of treatment remains largely unknown. We sought to assess the comparative effect of these agents on heart failure outcomes. Methods This study was registered in the International Prospective Register of Systematic Reviews (CRD 42016042063). MEDLINE, EMBASE, and the Cochrane Library Central Register of Controlled Trials were searched. For the primary outcomes reported previously, studies between Jan 1, 1980 and June 30, 2016 were screened, and subsequently updated till Jan 24, 2019. We performed network meta-analysis to obtain estimates for the outcomes of heart failure, in particular by rankograms for ranking of heart failure risk as well as by pairwise comparisons among all classes of anti-diabetic medications. Results A total of 91 trials were included, among which were 171,253 participants and 4163 reported cases of heart failure events. As for rankograms, the surface under the cumulative ranking curves (SUCRA) of sodium-glucose co-transporters 2 and thiazolidinediones were 93.4% and 4.3%, respectively, signifying the lowest and highest risk of heart failure, respectively. As for pairwise comparisons in the network, sodium-glucose co-transporters 2 were significantly superior to insulin (OR: 0.75, 95% CI 0.62–0.91), dipeptidyl peptidase 4 inhibitors (OR: 0.68, 95% CI 0.59–0.78), glucagon-like peptide-1 receptor agonists (OR: 0.65, 95% CI 0.54–0.78), and thiazolidinediones (OR: 0.46, 95% CI 0.27–0.77) in terms of heart failure risk. Furthermore, in an exploratory analysis among subjects with underlying heart failure or at risk of heart failure, the superiority of sodium-glucose co-transporters 2 was still significant. Conclusions In terms of heart failure risk, sodium-glucose co-transporters 2 were the most favorable option among all classes of anti-diabetic medications. Electronic supplementary material The online version of this article (10.1186/s12933-019-0853-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Da-Ya Yang
- Department of Cardiology, First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Xin He
- Department of Cardiology, First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Hui-Wei Liang
- Administrative Office of Clinical Trial Center, Guangzhou Hui-Ai Hospital, Guangzhou, China
| | - Shao-Zhao Zhang
- Department of Cardiology, First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Xiang-Bin Zhong
- Department of Cardiology, First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Chu-Fan Luo
- Department of Cardiology, First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Zhi-Min Du
- Department of Cardiology, First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Jian-Gui He
- Department of Cardiology, First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Dong Zhuang
- Department of Cardiology, First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China. .,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China.
| | - Xin-Xue Liao
- Department of Cardiology, First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China. .,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China.
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Abstract
IN BRIEF The number of medications used to treat diabetes has increased dramatically in the past 15 years. With so many options that have shown significant A1C improvement, it is important to consider side effects, precautions, and additional benefits these agents may offer. This article is a review of some of the most compelling literature available on the nonglycemic benefits of sulfonylureas, thiazolidinediones, biguanides, glucagon-like peptide 1 receptor agonists, dipeptidyl peptidase 4 inhibitors, and sodium-glucose cotransporter 2 inhibitors. Other classes of antihyperglycemic agents, such as dopamine agonists, meglitinides, and amylin agonists, are not discussed in this article.
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Affiliation(s)
| | - David Sze
- Becton Dickinson and Company, Andover, MA
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Lee SJ, Ha KH, Lee JH, Lee H, Kim DJ, Kim HC. Second-line glucose-lowering drugs added to metformin and the risk of hospitalization for heart failure: A nationwide cohort study. PLoS One 2019; 14:e0211959. [PMID: 30742667 PMCID: PMC6370220 DOI: 10.1371/journal.pone.0211959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/24/2019] [Indexed: 11/19/2022] Open
Abstract
AIM To compare the risks of hospitalization for heart failure (HHF) associated with sulfonylurea (SU), dipeptidyl peptidase-4 inhibitor (DPP-4i), and thiazolidinedione (TZD) as add-on medications to metformin (MET) therapy using the data of Korean adults with type-2 diabetes from the Korean National Health Insurance database. METHODS We identified 98,383 people who received SU (n = 42,683), DPP-4i (n = 50,310), or TZD (n = 5,390) added to initial treatment of MET monotherapy in patients with type-2 diabetes. The main outcome was the hospitalization for HHF. Hazard ratios for HHF by type of second-line glucose-lowering medication were estimated by Cox-proportional hazard models. Sex, age, duration of MET monotherapy, Charlson Comorbidity Index and additional comorbidities, and calendar year were controlled as potential confounders. RESULTS The observed numbers (rate per 100,000 person-years) of HHF events were 1,129 (658) for MET+SU users, 710 (455) for MET+DPP-4i users, and 110 (570) for MET+TZD users. Compared to that for MET+SU users (reference group), the adjusted hazard ratios for HHF events were 0.76 (95% confidence interval 0.69-0.84) for MET+DPP-4i users and 0.96 (95% confidence interval 0.79-1.17) for MET+TZD users. CONCLUSION DPP-4i as an add-on therapy to MET may lower the risks of HHF compared with SU.
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Affiliation(s)
- Su Jin Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
- Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea
| | - Jung Hyun Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hokyou Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
- Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular and Metabolic Disease Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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Greene SJ, Vaduganathan M, Khan MS, Bakris GL, Weir MR, Seltzer JH, Sattar N, McGuire DK, Januzzi JL, Stockbridge N, Butler J. Prevalent and Incident Heart Failure in Cardiovascular Outcome Trials of Patients With Type 2 Diabetes. J Am Coll Cardiol 2018; 71:1379-1390. [PMID: 29534825 PMCID: PMC5832063 DOI: 10.1016/j.jacc.2018.01.047] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/16/2018] [Accepted: 01/22/2018] [Indexed: 02/06/2023]
Abstract
Despite multiple examples of glucose-lowering therapies affecting heart failure (HF) risk, ascertainment of HF data in cardiovascular outcome trials of these medications has not been systematically characterized. In this review, large (n >1,000) published phase III and IV cardiovascular outcome trials evaluating glucose-lowering therapies through June 2017 were identified. Data were abstracted from publications, U.S. Food and Drug Administration advisory committee records, and U.S. Food and Drug Administration labeling documents. Overall, 21 trials including 152,737 patients were evaluated. Rates and definitions of baseline HF and incident HF were inconsistently provided. Baseline ejection fraction data were provided in 3 studies but not specific to patients with HF. No trial reported functional class, ejection fraction, or HF therapy at the time of incident HF diagnosis. HF hospitalization data were available in 15 trials, but only 2 included HF-related events within the primary composite endpoint. This systematic review highlights gaps in HF data capture within cardiovascular outcome trials of glucose-lowering therapies and outlines rationale and strategies for improving HF characterization.
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Affiliation(s)
- Stephen J Greene
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
| | | | - George L Bakris
- ASH Comprehensive Hypertension Center, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Darren K McGuire
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Norman Stockbridge
- Division of Cardiovascular and Renal Products, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, Mississippi.
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14
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Xia C, Goud A, D'Souza J, Dahagam CH, Rao X, Rajagopalan S, Zhong J. DPP4 inhibitors and cardiovascular outcomes: safety on heart failure. Heart Fail Rev 2018; 22:299-304. [PMID: 28417296 DOI: 10.1007/s10741-017-9617-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Diabetes is an important risk factor for cardiovascular disease. However, clinical data suggests intensive glycemic control significantly increase rather than decrease cardiovascular mortality, which is largely due to the fact that a majority of oral anti-diabetic drugs have adverse cardiovascular effect. There are several large-scale clinical trials evaluating the cardiovascular safety of DPP4 inhibitors, a novel class of oral anti-diabetic medications, which have been recently completed. They were proven to be safe with regard to cardiovascular outcomes. However, concerns on the safety of heart failure have been raised as the SAVOR-TIMI 53 trial reported a 27% increase in the risk for heart failure hospitalization in diabetic patients treated with DPP4 inhibitor saxagliptin. In this review, we will discuss recent advances in the heart failure effects of DPP4 inhibition and GLP-1 agonism.
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Affiliation(s)
- Chang Xia
- College of Health Science & Nursing, Wuhan Polytechnic University, Wuhan, Hubei, China
- Cardiovascular Research Institute, Case Western Reserve University, 2103 Cornell Road, Wolstein Research Building RM 4525, Cleveland, OH, 44106, USA
| | - Aditya Goud
- Cardiovascular Research Institute, Case Western Reserve University, 2103 Cornell Road, Wolstein Research Building RM 4525, Cleveland, OH, 44106, USA
| | - Jason D'Souza
- Divisionof Internal Medicine, Florida Hospital, Orlando, FL, 32804, USA
| | - CHanukya Dahagam
- Division of Internal Medicine, MedStar Health, Baltimore, MD, 21237, USA
| | - Xiaoquan Rao
- Cardiovascular Research Institute, Case Western Reserve University, 2103 Cornell Road, Wolstein Research Building RM 4525, Cleveland, OH, 44106, USA
| | - Sanjay Rajagopalan
- Cardiovascular Research Institute, Case Western Reserve University, 2103 Cornell Road, Wolstein Research Building RM 4525, Cleveland, OH, 44106, USA
| | - Jixin Zhong
- Cardiovascular Research Institute, Case Western Reserve University, 2103 Cornell Road, Wolstein Research Building RM 4525, Cleveland, OH, 44106, USA.
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15
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Scheen AJ. Pharmacokinetic Characteristics and Clinical Efficacy of an SGLT2 Inhibitor Plus DPP-4 Inhibitor Combination Therapy in Type 2 Diabetes. Clin Pharmacokinet 2018; 56:703-718. [PMID: 28039605 DOI: 10.1007/s40262-016-0498-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Type 2 diabetes (T2D) generally requires a combination of several pharmacological approaches to control hyperglycaemia. Combining a sodium-glucose cotransporter type 2 inhibitor (SGLT2I, also known as gliflozin) and a dipeptidyl peptidase-4 inhibitor (DPP-4I, also known as gliptin) appears to be an attractive strategy because of complementary modes of action. This narrative review analyzes the pharmacokinetics and clinical efficacy of different combined therapies with an SGLT2I (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin, ipragliflozin, luseogliflozin, tofogliflozin) and DPP-4I (linagliptin, saxagliptin, sitagliptin, teneligliptin). Drug-drug pharmacokinetic interaction studies do not show any significant changes in peak concentrations (C max) and total exposure (area under the curve of plasma concentrations [AUC]) of either drug when they were administered together orally compared with corresponding values when each of them was absorbed alone. Two fixed-dose combinations (FDCs) are already available (dapagliflozin-saxagliptin, empagliflozin-linagliptin) and others are in development (ertugliflozin-sitagliptin). Preliminary results show bioequivalence of the two medications administered as FDC tablets when compared with coadministration of the individual tablets. Dual therapy is more potent than either monotherapy in patients treated with diet and exercise or already treated with metformin. SGLT2I and DPP-4I could be used as initial combination or in a stepwise approach. The additional glucose-lowering effect appears to be more marked when a gliflozin is added to a gliptin than when a gliptin is added to a gliflozin. Combining the two pharmacological options is safe and does not induce hypoglycaemia.
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Affiliation(s)
- André J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Liège, CHU Sart Tilman (B35), 4000, Liège 1, Belgium. .,Division of Clinical Pharmacology, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium.
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Fu S, Ping P, Wang F, Luo L. Synthesis, secretion, function, metabolism and application of natriuretic peptides in heart failure. J Biol Eng 2018; 12:2. [PMID: 29344085 PMCID: PMC5766980 DOI: 10.1186/s13036-017-0093-0] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/21/2017] [Indexed: 12/11/2022] Open
Abstract
As a family of hormones with pleiotropic effects, natriuretic peptide (NP) system includes atrial NP (ANP), B-type NP (BNP), C-type NP (CNP), dendroaspis NP and urodilatin, with NP receptor-A (guanylate cyclase-A), NP receptor-B (guanylate cyclase-B) and NP receptor-C (clearance receptor). These peptides are genetically distinct, but structurally and functionally related for regulating circulatory homeostasis in vertebrates. In humans, ANP and BNP are encoded by NP precursor A (NPPA) and NPPB genes on chromosome 1, whereas CNP is encoded by NPPC on chromosome 2. NPs are synthesized and secreted through certain mechanisms by cardiomyocytes, fibroblasts, endotheliocytes, immune cells (neutrophils, T-cells and macrophages) and immature cells (embryonic stem cells, muscle satellite cells and cardiac precursor cells). They are mainly produced by cardiovascular, brain and renal tissues in response to wall stretch and other causes. NPs provide natriuresis, diuresis, vasodilation, antiproliferation, antihypertrophy, antifibrosis and other cardiometabolic protection. NPs represent body's own antihypertensive system, and provide compensatory protection to counterbalance vasoconstrictor-mitogenic-sodium retaining hormones, released by renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS). NPs play central roles in regulation of heart failure (HF), and are inactivated through not only NP receptor-C, but also neutral endopeptidase (NEP), dipeptidyl peptidase-4 and insulin degrading enzyme. Both BNP and N-terminal proBNP are useful biomarkers to not only make the diagnosis and assess the severity of HF, but also guide the therapy and predict the prognosis in patients with HF. Current NP-augmenting strategies include the synthesis of NPs or agonists to increase NP bioactivity and inhibition of NEP to reduce NP breakdown. Nesiritide has been established as an available therapy, and angiotensin receptor blocker NEP inhibitor (ARNI, LCZ696) has obtained extremely encouraging results with decreased morbidity and mortality. Novel pharmacological approaches based on NPs may promote a therapeutic shift from suppressing the RAAS and SNS to re-balancing neuroendocrine dysregulation in patients with HF. The current review discussed the synthesis, secretion, function and metabolism of NPs, and their diagnostic, therapeutic and prognostic values in HF.
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Affiliation(s)
- Shihui Fu
- Department of Geriatric Cardiology, Chinese People’s Liberation Army General Hospital, Beijing, 100853 China
- Department of Cardiology and Hainan Branch, Chinese People’s Liberation Army, General Hospital, Beijing, China
| | - Ping Ping
- Department of Pharmaceutical Care, Chinese People’s, Liberation Army General Hospital, Beijing, China
| | - Fengqi Wang
- Department of Cardiology and Hainan Branch, Chinese People’s Liberation Army, General Hospital, Beijing, China
| | - Leiming Luo
- Department of Geriatric Cardiology, Chinese People’s Liberation Army General Hospital, Beijing, 100853 China
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Dipeptidyl peptidase-4 inhibitors and cancer risk in patients with type 2 diabetes: a meta-analysis of randomized clinical trials. Sci Rep 2017; 7:8273. [PMID: 28811622 PMCID: PMC5557948 DOI: 10.1038/s41598-017-07921-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 07/03/2017] [Indexed: 01/21/2023] Open
Abstract
Some recent studies have suggested that the use of dipeptidyl peptidase-4 inhibitors (DPP4i) is associated with cancer development. However, some other studies suggest no such association. The aim of the present study was to evaluate the effect of DPP4i on the risk of developing cancers. The electronic databases PubMed, Medline, EMBASE, Web of Science and Cochrane Library and the clinical trial registry were searched for published and unpublished randomized clinical trials on humans. Eligible studies were RCTs conducted in patients with type 2 diabetes mellitus, comparing DPP4i with a placebo or other active drugs. A total of 72 trials with 35,768 and 33,319 patients enrolled for DPP4i and the comparison drugs, respectively. Overall, no significant associations were detected between the use of DPP4i and cancer development, in comparison with the use of other active drugs or placebo. The results were consistent across pre-defined subgroups stratified by type of DPP4i, type of cancer, drug for comparison, trial duration, or baseline characteristics. The results of this meta-analysis suggest that patients with type 2 diabetes treated with DPP4i do not have a higher risk of developing cancers than patients treated with a placebo or other drugs.
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Abstract
Since the FDA requirement for cardiovascular safety of all new antihyperglycemic drugs to enter the market, the number and extent of phase 3 clinical trials has markedly increased. Unexpected trial results imply an enormous economic, personal and time cost and has deleterious effects over R&D. To prevent unforeseen developments in clinical trials, we recommend performing a comprehensive prospective outcome scenario analysis before launching the trial. In this commentary, we discuss the most important factors to take in consideration for prediction of clinical trial outcome scenarios and propose a theoretical model for decision making.
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Affiliation(s)
| | | | - Oliver Schnell
- Sciarc Institute, Baierbrunn, Germany
- Forschergruppe Diabetes e.V. at the Helmholtz Center, Munich-Neuherberg, Germany
- Oliver Schnell, MD, Forschergruppe Diabetes e.V. at the Helmholtz Center, Munich-Neuherberg, Germany. Ingolstädter Landstraße 1, 85764 München-Neuherberg, Germany.
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19
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Fadini GP, Bonora BM, Albiero M, Zaninotto M, Plebani M, Avogaro A. DPP-4 inhibition has no acute effect on BNP and its N-terminal pro-hormone measured by commercial immune-assays. A randomized cross-over trial in patients with type 2 diabetes. Cardiovasc Diabetol 2017; 16:22. [PMID: 28183314 PMCID: PMC5301429 DOI: 10.1186/s12933-017-0507-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/03/2017] [Indexed: 12/14/2022] Open
Abstract
Background Use of dipeptidyl peptidase-4 inhibitors (DPP4-i) for the treatment of type 2 diabetes (T2D) has been associated with a possible increase in the risk for heart failure (HF). B-type natriuretic peptide (BNP), which is both a biomarker of HF and a hemodynamically active hormone, is a substrate of DPP-4. We herein tested the acute effects of the DPP-4i linagliptin on BNP and NT-proBNP in a cross-over placebo-controlled trial in patients with T2D with and without chronic kidney disease (CKD). Methods B-type natriuretic peptide and NT-proBNP were measured using commercially available clinical-grade immune-assays at baseline and at the end of a 4-day treatment with placebo and linagliptin. Changes from baseline during each treatment arm, as well as placebo-subtracted effects of linagliptin on BNP and NT-proBNP were calculated. Results 46 patients completed the study, 18 of whom were affected by CKD. Baseline BNP and NT-proBNP levels increased with age, were elevated in CKD patients, and inversely correlated with estimated glomerular filtration rate. No significant change was detected in BNP and NT-proBNP levels after treatment with linagliptin or placebo in patients with or without CKD. Only in CKD patients the placebo-subtracted effect of linagliptin indicated a significant reduction in NT-proBNP levels, but this finding was not statistically robust. Conclusions Acute treatment with a DPP-4i exerts no clinically-meaningful effects on BNP and NT-proBNP. As routinely used immunoassays do not discriminate between intact/active and cleaved BNP, these data cannot rule out an effect of DPP-4i on HF pathophysiology. Trial registration NCT01617824
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Affiliation(s)
- Gian Paolo Fadini
- Department of Medicine, University of Padova, Via Giustiniani,2, 35128, Padua, Italy.
| | | | - Mattia Albiero
- Department of Medicine, University of Padova, Via Giustiniani,2, 35128, Padua, Italy
| | - Martina Zaninotto
- Department of Medicine, University of Padova, Via Giustiniani,2, 35128, Padua, Italy
| | - Mario Plebani
- Department of Medicine, University of Padova, Via Giustiniani,2, 35128, Padua, Italy
| | - Angelo Avogaro
- Department of Medicine, University of Padova, Via Giustiniani,2, 35128, Padua, Italy
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Kalra S, Gupta Y, Baruah M. Can cardiac autonomic neuropathy be a predictor of cardiovascular outcomes in diabetes? Indian J Endocrinol Metab 2015; 19:196-7. [PMID: 25729680 PMCID: PMC4319258 DOI: 10.4103/2230-8210.145795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and B.R.I.D.E., Karnal, Haryana, India
| | - Yashdeep Gupta
- Department of Medicine, Government Medical College, Chandigarh, India
| | - Manash Baruah
- Department of Endocrinology, Excel Hospitals, Guwahati, Assam, India
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