Liraglutide Improves Forced Vital Capacity in Individuals With Type 2 Diabetes: Data From the Randomized Crossover LIRALUNG Study

To evaluate the effect of liraglutide, a glucagon-like peptide 1 receptor agonist, on pulmonary function and serum levels of surfactant protein D (SP-D) in type 2 diabetes. A double-blind, randomized, crossover, placebo-controlled clinical trial comprising 76 patients with a baseline forced expiratory volume in 1 s <90% of that predicted. Liraglutide was administered for 7 weeks (2 weeks of titration plus 5 weeks at 1.8 mg daily). This short duration was intentional to minimize weight loss as a potential confounding factor. Serum level of SP-D was used as a biomarker of alveolar-capillary barrier integrity. Liraglutide exerted a positive impact on forced vital capacity (FVC) in comparison with placebo (ΔFVC 5.2% of predicted [from 0.8 to 9.6]; P = 0.009). No differences in the other pulmonary variables were observed. Participants under liraglutide treatment also experienced a decrease in serum SP-D (P = 0.038). The absolute change in FVC correlated with final serum SP-D in participants receiving liraglutide (r = -0.313, P = 0.036). Stepwise multivariate regression analysis showed that final serum SP-D independently predicted changes in FVC. In conclusion, liraglutide increased FVC in patients with type 2 diabetes. This effect was associated with a significant decrease of circulating SP-D, thus pointing to a beneficial effect in the alveolar-capillary function.

Subclinical impairment of lung function is related to mild cardiac dysfunction and manifest heart failure in the general population

BACKGROUND

Lung function impairment has previously been related to heart failure, although no overt cardiovascular or structural heart disease is present. The extent to which pulmonary function is related to subclinical left ventricular impairment in the general population remains to be investigated.

METHODS

15010 individuals from the general population (mean age 55±11years, 50.5% men) in the Gutenberg Health Study underwent spirometry, transthoracic echocardiography and biomarker measurement. Forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC) in percent of the predicted value and FEV1/FVC ratio were associated with echocardiographic measures of cardiac structure, systolic and diastolic function, biomarkers of cardiac necrosis (high-sensitive troponin I, hsTnI) and stress (N-terminal pro-B-type natriuretic peptide, Nt-proBNP) and heart failure with preserved (HFpEF) and reduced ejection fraction (HFrEF).

RESULTS

Percent predicted FEV1 and FVC were significantly associated with hsTnI (P<0.001) and Nt-proBNP (P<0.001). Additionally, FEV1/FVC ratio was significantly related to hsTnI (P=0.0043) and Nt-proBNP (P<0.001). In the multivariable-adjusted linear regression analyses strongest associations were observed for percent predicted FEV1 and FVC with LVESD, E/e', SV and EF. FEV1/FVC ratio was significantly related with SV and EF. The three lung function parameters were significantly (P<0.001) associated with HFpEF and HFrEF. Associations remained statistically significant after exclusion of individuals with COPD.

CONCLUSIONS

FEV1, FVC and FEV1/FVC ratio were associated with systolic and diastolic function and manifest heart failure. Our observations could show, that subclinical lung function impairment is related to a measurable reduction of left ventricular filling and cardiac output in the general population.

Gender influences the relationship between lung function and cardiac remodeling in hypertensive subjects

Hypertensive patients are predisposed to left ventricular (LV) remodeling and frequently exhibit decline in lung function as compared with the general population. Here, we investigated the association between spirometric and echocardiographic data in non-smoking hypertensive subjects and the role of gender in this regard. In a cross-sectional study, 107 hypertensive patients (60 women) enrolled from a university outpatient clinic were evaluated by clinical, hemodynamic, laboratory and echocardiographic analysis. Vital capacity, forced vital capacity (FVC), forced expired volume in 1 s (FEV1) and in 6 s (FEV6), FEV1/FVC ratio and FEV1/FEV6 ratio were estimated by spirometry. In women, higher LV mass index and E/Em ratio correlated with markers of restrictive lung alterations, such as reduced FVC (r=-044; P<0.001; r=-0.42; P<0.001, respectively) and FEV6 (r=-0.43; P<0.001; r=-0.39; P<0.01, respectively), while higher left atrial volume index correlated with markers of obstructive lung alterations, such as reduced FEV1/FVC (r=-055; P<0.001) and FEV1/FEV6 (r=-0.45; P<0.001) ratios. These relationships were further confirmed by stepwise regression analysis adjusted for potential confounders. In men, LV mass index correlated with FVC and FEV6, but these associations did not remain statistically significant after adjustment for confounding variables. Furthermore, inflammatory markers such as plasma C-reactive protein and matrix-metalloproteinases-2 and -9 levels did not influence the association between spirometric and cardiac parameters. In conclusion, these results indicate that LV remodeling is related to restrictive lung alterations while left atrial remodeling is associated with obstructive lung alterations in hypertensive women.