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Bonilha I, Gomes ÉIL, Carmo HRP, Breder I, Barreto J, Breder J, Munhoz DB, Carvalho LSF, Quinaglia T, Kimura-Medorima ST, Gossi CM, Zimetti F, Nadruz W, Zanotti I, Sposito AC. Effect of Empagliflozin with or without the Addition of Evolocumab on HDL Subspecies in Individuals with Type 2 Diabetes Mellitus: A Post Hoc Analysis of the EXCEED-BHS3 Trial. Int J Mol Sci 2024; 25:4108. [PMID: 38612917 PMCID: PMC11012560 DOI: 10.3390/ijms25074108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
Evolocumab and empagliflozin yield a modest rise in plasma high-density lipoprotein cholesterol (HDL-C) through unknown mechanisms. This study aims to assess the effect of evolocumab plus empagliflozin vs. empagliflozin alone on HDL subspecies isolated from individuals with type 2 diabetes mellitus (T2D). This post hoc prespecified analysis of the EXCEED-BHS3 trial compared the effects of a 16-week therapy with empagliflozin (E) alone or in combination with evolocumab (EE) on the lipid profile and cholesterol content in HDL subspecies in individuals with T2D divided equally into two groups of 55 patients. Both treatments modestly increased HDL-C. The cholesterol content in HDL subspecies 2a (7.3%), 3a (7.2%) and 3c (15%) increased from baseline in the E group, while the EE group presented an increase from baseline in 3a (9.3%), 3b (16%) and 3c (25%). The increase in HDL 3b and 3c was higher in the EE group when compared to the E group (p < 0.05). No significant interactive association was observed between changes in hematocrit and HDL-C levels after treatment. Over a 16-week period, empagliflozin with or without the addition of evolocumab led to a modest but significant increase in HDL-C. The rise in smaller-sized HDL particles was heterogeneous amongst the treatment combinations.
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Affiliation(s)
- Isabella Bonilha
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
| | - Érica Ivana Lázaro Gomes
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
| | - Helison R. P. Carmo
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
| | - Ikaro Breder
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
| | - Joaquim Barreto
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
| | - Jessica Breder
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
| | - Daniel B. Munhoz
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium
| | - Luiz Sergio F. Carvalho
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
| | - Thiago Quinaglia
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
| | - Sheila T. Kimura-Medorima
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
| | - Camila Moreira Gossi
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
| | - Francesca Zimetti
- Department of Food and Drug, University of Parma, 43124 Parma, Italy; (F.Z.); (I.Z.)
| | - Wilson Nadruz
- Division of Cardiology, State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil;
| | - Ilaria Zanotti
- Department of Food and Drug, University of Parma, 43124 Parma, Italy; (F.Z.); (I.Z.)
| | - Andrei C. Sposito
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
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Hardonova M, Siarnik P, Sivakova M, Sucha B, Penesova A, Radikova Z, Havranova A, Imrich R, Vlcek M, Zitnanova I, Krastev G, Kiacikova M, Kollar B, Turcani P. Endothelial Function in Patients with Multiple Sclerosis: The Role of GLP-1 Agonists, Lipoprotein Subfractions, and Redox Balance. Int J Mol Sci 2023; 24:11162. [PMID: 37446338 DOI: 10.3390/ijms241311162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Epidemiological studies have suggested an increased vascular risk in patients with multiple sclerosis (MS). There is increasing evidence of the beneficial effects of GLP-1 agonists (GLP-1a) in preventing vascular complications and slowing the progression of neurodegeneration. Our objective was to explore the changes in the endothelial function of MS patients after 12 months of GLP-1a therapy. We also explored the role of lipoprotein subfractions and the antioxidant capacity of plasma. METHODS MS patients were enrolled in a prospective, unicentric study. GLP-1a (dulaglutide) was administered to 13 patients. The control population consisted of 12 subjects. Endothelial function was determined by peripheral arterial tonometry and expressed as reperfusion hyperemia index (RHI). Trolox equivalent antioxidant capacity (TEAC) was used to assess the total antioxidant capacity of the plasma. The levels of lipoprotein subfractions were evaluated. RESULTS The GLP-1a group did not have a significant change in their RHIs after 12 months (2.1 ± 0.6 vs. 2.1 ± 0.7; p = 0.807). However, a significant increase in their TEACs was observed (4.1 ± 1.4 vs. 5.2 ± 0.5 mmol/L, p = 0.010). On the contrary, the subjects in the control group had a significant worsening of their RHIs (2.1 ± 0.5 vs. 1.8 ± 0.6; p = 0.030), without significant changes in their TEACs. Except for a significant decrease in very-low-density lipoprotein (VLDL) (30.8 ± 10.2 vs. 22.6 ± 8.3 mg/dL, p = 0.043), no other significant changes in the variables were observed in the control group. VLDL levels (beta = -0.637, p = 0.001), the use of GLP-1a therapy (beta = 0.560, p = 0.003), and small LDL (beta = 0.339, p = 0.043) were the only significant variables in the model that predicted the follow-up RHI. CONCLUSION Our results suggest that the application of additional GLP-1a therapy may have atheroprotective and antioxidant effects in MS patients with high MS activity and thus may prospectively mitigate their vascular risk. However, the lipoprotein profile may also play an important role in the atherogenic risk of MS subjects.
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Affiliation(s)
- Miroslava Hardonova
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 813 69 Bratislava, Slovakia
| | - Pavel Siarnik
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 813 69 Bratislava, Slovakia
| | - Monika Sivakova
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 813 69 Bratislava, Slovakia
| | - Bianka Sucha
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 813 69 Bratislava, Slovakia
| | - Adela Penesova
- Institute of Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| | - Zofia Radikova
- Institute of Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| | - Andrea Havranova
- Institute of Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| | - Richard Imrich
- Institute of Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| | - Miroslav Vlcek
- Institute of Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| | - Ingrid Zitnanova
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, 811 08 Bratislava, Slovakia
| | - Georgi Krastev
- Department of Neurology, Faculty Hospital, 917 75 Trnava, Slovakia
| | - Maria Kiacikova
- Department of Neurology, Faculty Hospital, 911 01 Trencin, Slovakia
| | - Branislav Kollar
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 813 69 Bratislava, Slovakia
| | - Peter Turcani
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 813 69 Bratislava, Slovakia
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Sposito AC, Breder I, Barreto J, Breder J, Bonilha I, Lima M, Oliveira A, Wolf V, Luchiari B, do Carmo HR, Munhoz D, Oliveira D, Coelho-Filho OR, Coelho OR, Matos-Souza JR, Moura FA, de Carvalho LSF, Nadruz W, Quinaglia T, Kimura-Medorima ST. Evolocumab on top of empagliflozin improves endothelial function of individuals with diabetes: randomized active-controlled trial. Cardiovasc Diabetol 2022; 21:147. [PMID: 35933413 PMCID: PMC9356512 DOI: 10.1186/s12933-022-01584-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve endothelial dysfunction and reduce cardiovascular events in individuals with type 2 diabetes (T2D). Proprotein convertase subtilisin/kexin 9 (PCSK9i) inhibitors reduce cardiovascular events in high-risk patients. Whether the addition of PCSK9i to SGLT2i treatment adds benefits is not known. Objectives To assess the PCSK9-i effect on the endothelial function of T2D individuals under treatment with SGLT2-i. Methods Individuals with T2D were randomized in a 1:1 ratio to a 16-week treatment with either empagliflozin (E) or empagliflozin plus evolocumab (EE). The primary endpoint was post-treatment change from baseline in flow-mediated dilation (FMD) at 1-min. Secondary outcomes included changes in plasma levels of nitric oxide metabolites and isoprostane. Results A total of 110 patients were enrolled, the mean age was 58 years, and 71% were men. The median post-treatment change in FMD at 1-min was 2.7% (interquartile range [IQR]: 0.9%) and 0.4% (IQR: 0.9%) in the EE and E groups, respectively (p < 0.001). There was a greater increase in plasma levels of nitrate [5.9 (16.5) vs. 2.6 (11.8); p = 0.001] and nitrite [0.14 (0.72) vs. 0.02 (0.74); p = 0.025] in the EE group than in the E group, respectively. Isoprostane reduction was more pronounced in the EE group when compared to the E group [−1.7 (5.9) vs. −1.1 (5.3); p < 0.001). Conclusions In individuals with T2D, the addition of evolocumab on top of empagliflozin improves endothelial function. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01584-8.
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Affiliation(s)
- Andrei C Sposito
- Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil. .,Brazilian Heart Study Group, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil.
| | - Ikaro Breder
- Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil
| | - Joaquim Barreto
- Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil
| | - Jessica Breder
- Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil
| | - Isabella Bonilha
- Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil
| | - Marcus Lima
- Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil
| | - Alessandra Oliveira
- Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil
| | - Vaneza Wolf
- Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil
| | - Beatriz Luchiari
- Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil
| | - Helison R do Carmo
- Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil
| | - Daniel Munhoz
- Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil
| | - Daniela Oliveira
- Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil
| | - Otavio R Coelho-Filho
- Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil
| | - Otavio R Coelho
- Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil
| | - Jose Roberto Matos-Souza
- Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil
| | - Filipe A Moura
- Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Luiz Sergio F de Carvalho
- Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil
| | - Wilson Nadruz
- Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil
| | - Thiago Quinaglia
- Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil
| | - Sheila T Kimura-Medorima
- Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil
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Rehberger Likozar A, Šebeštjen M. Smoking and diabetes attenuate beneficial effects of PSCK9 inhibitors on arterial wall properties in patients with very high lipoprotein (a) levels. ATHEROSCLEROSIS PLUS 2022; 50:1-9. [PMID: 36643800 PMCID: PMC9833244 DOI: 10.1016/j.athplu.2022.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/08/2022] [Accepted: 07/15/2022] [Indexed: 01/18/2023]
Abstract
Background and aims Elevated lipoprotein (a) (Lp(a)) and low-density lipoprotein cholesterol levels (LDL-C) are significant residual risk factors for cardiovascular events. Treatment with protein convertase subtilisin kexin type 9 (PCSK9) inhibitors reduces the levels of both. Less is known about effects of PCSK9 inhibitors on functional and morphological properties of the arterial wall. The aim of the present study was to determine whether other factors besides decreased LDL-C and Lp(a) are associated with functional (flow-mediated dilation [FMD]) and morphological (carotid intima-media thickness [c-IMT], pulse-wave velocity [PWV]) changes of the arterial wall properties in patients with coronary artery disease (CAD) treated with alirocumab and evolocumab. Methods One hundred patients with CAD after myocardial infarction before 55 years and with high Lp(a) were randomised to lipid-lowering therapies without PCSK9 inhibitors (control; N = 31), or with alirocumab 150 mg SC (N = 35) or evolocumab 140 mg SC (N = 34), every 2 weeks. All patients underwent blood sampling for biochemical analyses and ultrasound measurements for FMD, c-IMT and PWV. Results There were no significant changes in FMD for the control (10.7% ± 6.6%-11.1% ± 4.4%, p = 0.716) and alirocumab (10.7% ± 5.9%-11.2% ± 5.3%, p = 0.547) groups, while evolocumab promoted significant increase (11.2% ± 6.8%-14.1% ± 6.6%, p < 0.0001). Only in non-smokers and non-diabetics significant improvements in FMD (p < 0.0001) after treatment with PCSK9 inhibitors were observed. Conclusion These data show that for patients with CAD and high Lp(a) levels, beneficial effects of PCSK9 inhibitors on the arterial wall properties can be attenuated by specific risk factors, such as smoking and diabetes.
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Affiliation(s)
| | - Miran Šebeštjen
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia,Department of Cardiology, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia,University of Ljubljana, Faculty of Medicine, 1000, Ljubljana, Slovenia,Corresponding author. Department of Cardiology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.
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Wei R, Wang W, Pan Q, Guo L. Effects of SGLT-2 Inhibitors on Vascular Endothelial Function and Arterial Stiffness in Subjects With Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Endocrinol (Lausanne) 2022; 13:826604. [PMID: 35250882 PMCID: PMC8889103 DOI: 10.3389/fendo.2022.826604] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/19/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to evaluate the effects of SGLT-2 inhibitors (SGLT-2i) on endothelial function and arteriosclerosis in diabetic patients. METHODS Randomized controlled trials (RCTs) were retrieved from PubMed, Embase, Cochrane Library, and Web of Science databases to evaluate the effects of SGLT-2i on endothelial function and atherosclerosis in type 2 diabetic patients. RESULTS We selected 9 RCTs and 2 cohort studys involving 868 patients. Of these, six studies provided flow-mediated dilation (FMD) levels before and after the intervention. The pooled analysis showed that SGLT-2i could significantly improve the FMD compared to the control group (SMD: 0.18, 95% CI: 0.02 ~ 0.34, P = 0.03). Three studies provided the change in FMD before and after the intervention. Pooled analysis showed no significant differences in FMD change between the SGLT-2i group and the control group. (MD: 2.1, 95%-CI: -0.11~4.31, P = 0.06). Five studies showed pulse wave velocity (PWV) results. Pooled analysis showed no significant differences in the change in PWV between the SGLT-2i group and the control group (SMD: 0.11, 95%-CI: - 0.15 ~ 0.37, P = 0.4). CONCLUSIONS The ability of SGLT-2 inhibitors to improve FMD was significant, but there was no significant effect on PWV levels. SGLT-2i was superior to other antidiabetic agents in improving arterial endothelial function.
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Affiliation(s)
- Ran Wei
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Fifth School of Clinical Medicine, Peking University, Beijing, China
| | - Weihao Wang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Pan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Fifth School of Clinical Medicine, Peking University, Beijing, China
- *Correspondence: Lixin Guo,
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Bonilha I, Hajduch E, Luchiari B, Nadruz W, Le Goff W, Sposito AC. The Reciprocal Relationship between LDL Metabolism and Type 2 Diabetes Mellitus. Metabolites 2021; 11:metabo11120807. [PMID: 34940565 PMCID: PMC8708656 DOI: 10.3390/metabo11120807] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/25/2021] [Accepted: 11/25/2021] [Indexed: 12/14/2022] Open
Abstract
Type 2 diabetes mellitus and insulin resistance feature substantial modifications of the lipoprotein profile, including a higher proportion of smaller and denser low-density lipoprotein (LDL) particles. In addition, qualitative changes occur in the composition and structure of LDL, including changes in electrophoretic mobility, enrichment of LDL with triglycerides and ceramides, prolonged retention of modified LDL in plasma, increased uptake by macrophages, and the formation of foam cells. These modifications affect LDL functions and favor an increased risk of cardiovascular disease in diabetic individuals. In this review, we discuss the main findings regarding the structural and functional changes in LDL particles in diabetes pathophysiology and therapeutic strategies targeting LDL in patients with diabetes.
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Affiliation(s)
- Isabella Bonilha
- Cardiology Division, Atherosclerosis and Vascular Biology Laboratory (AtheroLab), State University of Campinas (Unicamp), Campinas 13083-887, Brazil; (I.B.); (B.L.)
| | - Eric Hajduch
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, F-75006 Paris, France;
| | - Beatriz Luchiari
- Cardiology Division, Atherosclerosis and Vascular Biology Laboratory (AtheroLab), State University of Campinas (Unicamp), Campinas 13083-887, Brazil; (I.B.); (B.L.)
| | - Wilson Nadruz
- Cardiology Division, Cardiovascular Pathophysiology Laboratory, State University of Campinas (Unicamp), Campinas 13083-887, Brazil;
| | - Wilfried Le Goff
- Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition, ICAN, Inserm, Sorbonne Université, F-75013 Paris, France;
| | - Andrei C. Sposito
- Cardiology Division, Atherosclerosis and Vascular Biology Laboratory (AtheroLab), State University of Campinas (Unicamp), Campinas 13083-887, Brazil; (I.B.); (B.L.)
- Correspondence: ; Tel.: +55-19-3521-7098; Fax: +55-19-3289-410
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Switch to SGLT2 Inhibitors and Improved Endothelial Function in Diabetic Patients with Chronic Heart Failure. Cardiovasc Drugs Ther 2021; 36:1157-1164. [PMID: 34519913 DOI: 10.1007/s10557-021-07254-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The use of sodium-glucose-cotransporter-type-2 inhibitors (SGLT2i) was associated in previous studies with an improved vascular function in non-human experimental models. We therefore sought to evaluate possible changes in endothelial function assessed by flow-mediated dilation (FMD) in patients with chronic heart failure (CHF) and type-2 diabetes mellitus (T2DM), switching from other oral hypoglycemic agents to SGLT2i in an observational study. METHODS Twenty-two consecutive outpatients with CHF and T2DM were enrolled after switching to SGLT2i therapy, and compared with 23 consecutive controls from the same registry comparable for principal clinical characteristics. In all patients, endothelial function was assessed by FMD at baseline and after 3 months of follow-up. RESULTS Three months of therapy with SGLT2i were associated with a statistically significant improvement in endothelial function (19.0 ± 5.7% vs 8.5 ± 4.1%, p < 0.0001); baseline levels of FMD were comparable between groups (p n.s.). Therapy with SGLT2i was significantly associated to improved FMD levels even at multivariable stepwise regression analysis (p < 0.001). CONCLUSIONS Switch to SGLT2i in patients with CHF and T2DM was associated in an observational non-randomized study with an improved endothelial function.
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Abstract
Alterations of endothelial function, inflammatory activation, and nitric oxide-cyclic guanosine monophosphate (NO-cGMP) pathway are involved in the pathophysiology of heart failure. Metabolic alterations have been studied in the myocardium of heart failure (HF) patients; alterations in ketone body and amino acid/protein metabolism have been described in patients affected by HF, as well as mitochondrial dysfunction and other modified metabolic signaling. However, their possible contributions toward cardiac function impairment in HF patients are not completely known. Recently, sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) have emerged as a new class of drugs designed to treat patients with type 2 diabetes (T2D), but have also been shown to be protective against HF-related events and CV mortality. To date, the protective cardiovascular effects of these drugs in patients with and without T2D are not completely understood and several mechanisms have been proposed. In this review, we discuss on vascular and metabolic effects of SGLT2i and GLP-1 in HF patients.
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Bonilha I, Zimetti F, Zanotti I, Papotti B, Sposito AC. Dysfunctional High-Density Lipoproteins in Type 2 Diabetes Mellitus: Molecular Mechanisms and Therapeutic Implications. J Clin Med 2021; 10:2233. [PMID: 34063950 PMCID: PMC8196572 DOI: 10.3390/jcm10112233] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 12/29/2022] Open
Abstract
High density lipoproteins (HDLs) are commonly known for their anti-atherogenic properties that include functions such as the promotion of cholesterol efflux and reverse cholesterol transport, as well as antioxidant and anti-inflammatory activities. However, because of some chronic inflammatory diseases, such as type 2 diabetes mellitus (T2DM), significant changes occur in HDLs in terms of both structure and composition. These alterations lead to the loss of HDLs' physiological functions, to transformation into dysfunctional lipoproteins, and to increased risk of cardiovascular disease (CVD). In this review, we describe the main HDL structural/functional alterations observed in T2DM and the molecular mechanisms involved in these T2DM-derived modifications. Finally, the main available therapeutic interventions targeting HDL in diabetes are discussed.
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Affiliation(s)
- Isabella Bonilha
- Atherosclerosis and Vascular Biology Laboratory (AtheroLab), Cardiology Department, State University of Campinas (Unicamp), Campinas 13084-971, Brazil;
| | - Francesca Zimetti
- Department of Food and Drug, University of Parma, 43124 Parma, Italy; (I.Z.); (B.P.)
| | - Ilaria Zanotti
- Department of Food and Drug, University of Parma, 43124 Parma, Italy; (I.Z.); (B.P.)
| | - Bianca Papotti
- Department of Food and Drug, University of Parma, 43124 Parma, Italy; (I.Z.); (B.P.)
| | - Andrei C. Sposito
- Atherosclerosis and Vascular Biology Laboratory (AtheroLab), Cardiology Department, State University of Campinas (Unicamp), Campinas 13084-971, Brazil;
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