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Skeik N, Elejla SA, Sethi A, Manunga J, Mirza A. Effects of SGLT2 inhibitors and GLP1-receptor agonists on cardiovascular and limb events in peripheral artery disease: A review. Vasc Med 2023; 28:62-76. [PMID: 36593757 DOI: 10.1177/1358863x221143811] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Peripheral artery disease (PAD) and diabetes mellitus are two overwhelming health problems associated with major cardiovascular (CV) and limb events, in addition to increased mortality, despite advances in medical therapies including statins and renin-angiotensin system inhibitors. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1-receptor agonists (GLP1-RA) are two new antihyperglycemic drug classes that have been associated with a significant reduction of major adverse cardiovascular events (MACE) in patients with type 2 diabetes (T2D) and CV risk. Whereas most studies had enrolled patients with T2D and concurrent CV disease (CVD), patients with PAD were obviously underrepresented. Furthermore, there was a signal of increased risk of amputation in one of the main trials with canagliflozin. We aim to provide a general review of the current literature and summarize societal guideline recommendations addressing the role of SGLT2i and GLP1-RA drugs in patients with CVD focusing on the PAD population when data are available. Endpoints of interest were MACE and, when available, major adverse limb events (MALE).
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Affiliation(s)
- Nedaa Skeik
- Vascular Medicine, Thrombophilia and Anticoagulation Clinic, Vein Center, and Vascular Laboratories, Allina Health Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Sewar A Elejla
- Al-Quds University - Al Azhar Branch, Gaza City, Palestine
| | - Anish Sethi
- College of Biological Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Jesse Manunga
- Al-Quds University - Al Azhar Branch, Gaza City, Palestine.,Vascular and Endovascular Surgery, and Vascular Research, Allina Health Minneapolis Heart Institute, Abbott Northwestern Hospital Health, Minneapolis, MN, USA
| | - Aleem Mirza
- Department of Cardiovascular and Vascular Surgery, University of Texas Health Science in Houston, McGovern Medial School, Houston, TX, USA
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Tammam AS, Gahlan AA, Taher MA, Haredy AM. Hantzsch Condensation Reaction as a Spectrofluorometric Method for Determination of Alogliptin, an Anti-diabetic Drug, in Pure, Tablet, Human, and rat plasma. LUMINESCENCE 2021; 37:543-550. [PMID: 34907663 DOI: 10.1002/bio.4178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/13/2021] [Accepted: 11/29/2021] [Indexed: 11/07/2022]
Abstract
To analyze alogliptin in its pharmaceutical dosage forms and human plasma, a sensitive, inexpensive, simple, and precise spectrofluorimetric method was developed and tested. Also, this method was used to investigate the drug pharmacokinetic behavior in the blood of rats. It is based on the Hantzsch reaction, which produces yellowish luminous products that can be detected spectrofluorometrically at 480 and 415 nm, emission, and excitation, respectively, when the primary amine group in the examined drug reacts with acetylacetone and formaldehyde. Several experimental parameters that affect the reaction product's development and stability were explored and improved. The curve of fluorescence and concentration for alogliptin was linear in the concentration range of 0.05-3.60 μg ml-1 . According to ICH criteria, the proposed approach was validated. The method was successfully utilized to evaluate the examined drug in dose formulations and spiked human plasma with high accuracy.
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Affiliation(s)
- Azza S Tammam
- Chemistry Department, Faculty of Science, Al-Azhar University, Assiut, Egypt
| | - Ahmed A Gahlan
- Chemistry Department, Faculty of Science, Al-Azhar University, Assiut, Egypt
| | - Mahmoud A Taher
- Chemistry Department, Faculty of Science, Al-Azhar University, Assiut, Egypt
| | - Ahmed M Haredy
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Merit University, New Sohag, Egypt
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Reeder JA, Gilbert BW, Moran DA. Comment: Managing Diabetes and Preventing Heart Disease: Have We Found a Safe and Effective Agent? Ann Pharmacother 2019; 53:1071. [DOI: 10.1177/1060028019862263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jacob A. Reeder
- Wesley Medical Center Department of Pharmacy, Wichita, KS, USA
| | | | - David A. Moran
- Wesley Medical Center Department of Pharmacy, Wichita, KS, USA
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Cheng JWM, Colucci V, Kalus JS, Spinler SA. Reply: Managing Diabetes and Preventing Heart Disease: Have We Found a Safe and Effective Agent? Ann Pharmacother 2019; 53:1072. [PMID: 31271040 DOI: 10.1177/1060028019862262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Carbone S, Dixon DL. The CANVAS Program: implications of canagliflozin on reducing cardiovascular risk in patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2019; 18:64. [PMID: 31138195 PMCID: PMC6540565 DOI: 10.1186/s12933-019-0869-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/10/2019] [Indexed: 12/18/2022] Open
Abstract
Canagliflozin is a sodium glucose co-transporter 2 (SGLT2) inhibitor that reduces blood glucose, as well as blood pressure, body weight, and albuminuria in patients with type 2 diabetes mellitus (T2DM). In the CANagliflozin cardioVascular Assessment Study (CANVAS) Program, patients with T2DM and high cardiovascular risk treated with canagliflozin had a significantly lower risk of the composite outcome of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke; hospitalization for heart failure; and renal outcomes, but also a greater risk of lower-limb amputation. Cardiovascular outcomes trials of some other T2DM agents (i.e., empagliflozin, dapagliflozin, liraglutide, semaglutide, albiglutide) have also shown potential cardiovascular and renal benefits. As a result, diabetes treatment guidelines have begun to incorporate consideration of cardiovascular and renal benefits into their treatment recommendations. Antihyperglycemic agents with proven beneficial cardiovascular effects represent a new opportunity for the diabetologist and cardiologist, in the setting of a multidisciplinary approach, to concomitantly improve glycemic control and reduce the risk of cardiovascular events in patients with T2DM. This review briefly discusses the pharmacology of canagliflozin, including clinical and preclinical data; it also describes the effects of canagliflozin on cardiovascular outcomes and side-effects, and compares these effects with other glucose-lowering agents with proven cardiovascular benefits.
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Affiliation(s)
- Salvatore Carbone
- Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, West Hospital, Room 529b, 1200 E Broad Street, Richmond, VA, 23298, USA.
| | - Dave L Dixon
- Department of Pharmacotherapy and Outcome Sciences, School of Pharmacy, Virginia Commonwealth University, 410 N. 12th Street, Richmond, VA, 23298, USA
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Pozo L, Bello F, Suarez A, Ochoa-Martinez FE, Mendez Y, Chang CH, Surani S. Novel pharmacological therapy in type 2 diabetes mellitus with established cardiovascular disease: Current evidence. World J Diabetes 2019; 10:291-303. [PMID: 31139316 PMCID: PMC6522760 DOI: 10.4239/wjd.v10.i5.291] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 02/05/2023] Open
Abstract
Cardiovascular diseases (CVDs) remain the leading cause of death in the world and in most developed countries. Patients with type 2 diabetes mellitus (T2DM) suffer from both microvascular and macrovascular diseases and therefore have higher rates of morbidity and mortality compared to those without T2DM. If current trends continue, the Center for Disease Control and Prevention estimates that 1 in 3 Americans will have T2DM by year 2050. As a consequence of the controversy surrounding rosiglitazone and the increasing prevalence of diabetes and CVDs, in 2008 the Food and Drug Administration (FDA) established new expectations for the evaluation of new antidiabetic agents, advising for pre and, in some cases, post-marketing data on major cardiovascular events. As a direct consequence, there has been a paradigm shift in new antidiabetic agents that has given birth to the recently published American Diabetes Association/European Association for the Study of Diabetes consensus statement recommending sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon like peptide-1 receptor agonists (GLP-1RA) in patients with T2DM and established CVD. As a result of over a decade of randomized placebo controlled cardiovascular outcome trials, the aforementioned drugs have received FDA approval for risk reduction of cardiovascular (CV) events in patients with T2DM and established CV disease. SGLT2i have been shown to have a stronger benefit in patients with congestive heart failure and diabetic kidney disease when compared to their GLP-1RA counterparts. These benefits are not withstanding additional considerations such as cost and the multiple FDA Black Box warnings. This topic is currently an emerging research area and this mini-review paper examines the role of these two novel classes of drugs in patients with T2DM with both confirmed, and at risk for, CVD.
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Affiliation(s)
- Leonardo Pozo
- University of Texas Rio Grande Valley - Doctors Hospital at Renaissance Internal Medicine Residency Program, Edinburg, TX 78539, United States
| | - Fatimah Bello
- University of Texas Rio Grande Valley - Doctors Hospital at Renaissance Internal Medicine Residency Program, Edinburg, TX 78539, United States
| | - Andres Suarez
- University of Texas Rio Grande Valley - Doctors Hospital at Renaissance Internal Medicine Residency Program, Edinburg, TX 78539, United States
| | - Francisco E Ochoa-Martinez
- Faculty of Medicine, Universidad Autonoma de Nuevo Leon, University Hospital “Dr. José Eleuterio González”, Monterrey, NL 66455, Mexico
| | - Yamely Mendez
- Faculty of Medicine “Dr. Alberto Romo Caballero”, Universidad Autonoma de Tamaulipas, Houston, TX 77058, United States
| | - Chelsea H Chang
- University of Texas Rio Grande Valley - Doctors Hospital at Renaissance Internal Medicine Residency Program, Edinburg, TX 78539, United States
| | - Salim Surani
- Medical Critical Care Services, Christus Spohn Hospitals-Corpus Christi, Corpus Christi, TX 78404, United States
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