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Jang J, Park S, Kim S, Kim SH, Oh YS, Sa YK, Hwang Y, Jang SW, Ihm SH, Choi Y. Clinical outcomes with the use of sodium-glucose cotransporter-2 inhibitors in patients with atrial fibrillation and type 2 diabetes mellitus: a multi-centre, real-world cohort study. Eur J Prev Cardiol 2024; 31:320-329. [PMID: 37798123 DOI: 10.1093/eurjpc/zwad322] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023]
Abstract
AIMS Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have been shown to improve cardiovascular outcomes and reduce the incidence of atrial fibrillation (AF) in patients with type 2 diabetes mellitus (T2DM). We investigated the clinical outcomes with and without the use of SGLT2is in patients with T2DM and concomitant AF. METHODS AND RESULTS We derived patient data from a clinical data warehouse constructed from the electronic medical records of seven medical centres. Data for 11 012 patients diagnosed with both AF and T2DM were analysed. New SGLT2i users were classified into the SGLT2i group and those who were not prescribed SGLT2is were classified into the control group. We performed a 1:2 propensity score (PS)-matching analysis. The primary endpoint was a composite of all-cause death or hospitalization due to heart failure (HF) events in 3 years. The PS-matched population consisted of 1115 patients in the SGLT2i group and 2050 patients in the control group. Incidence of the primary endpoint was significantly lower in the SGLT2i group [8.4 vs. 14.6%, hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.55-0.87]. Sodium-glucose cotransporter-2 inhibitors use was associated with significantly lower all-cause mortality (HR 0.43, 95% CI 0.29-0.67) and HF hospitalization (HR 0.77, 95% CI 0.59-0.99). Adverse renal events, defined as >50% increase in serum creatinine level or initiation of dialysis, occurred less often in the SGLT2i group (HR 0.50, 95% CI 0.38-0.66, P < 0.001). CONCLUSION Use of SGLT2is in patients with T2DM and concomitant AF was associated with reduced mortality or HF hospitalization events.
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Affiliation(s)
- Jaehyuk Jang
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St.Mary's Hospital, College of Medicine, The Catholic University of Korea, 271 Cheonboro, Uijeongbu, Gyeonggido 11765, South Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
| | - Soyoon Park
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
| | - Soohyun Kim
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
| | - Sung-Hwan Kim
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
| | - Yong-Seog Oh
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
| | - Young Kyoung Sa
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Yeouido St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Youmi Hwang
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Sung-Won Jang
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sang-Hyun Ihm
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Bucheon St.Mary's Hospital, The Catholic University of Korea, Bucheon, South Korea
| | - Young Choi
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
- Division of Cardiology, Department of Internal Medicine, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul 06591, South Korea
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Peppa M, Manta A, Mavroeidi I, Asimakopoulou A, Syrigos A, Nastos C, Pikoulis E, Kollias A. Changes in Cardiovascular and Renal Biomarkers Associated with SGLT2 Inhibitors Treatment in Patients with Type 2 Diabetes Mellitus. Pharmaceutics 2023; 15:2526. [PMID: 38004506 PMCID: PMC10675228 DOI: 10.3390/pharmaceutics15112526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 11/26/2023] Open
Abstract
Type 2 diabetes mellitus is a major health problem worldwide with a steadily increasing prevalence reaching epidemic proportions. The major concern is the increased morbidity and mortality due to diabetic complications. Traditional but also nontraditional risk factors have been proposed to explain the pathogenesis of type 2 diabetes mellitus and its complications. Hyperglycemia has been considered an important risk factor, and the strict glycemic control can have a positive impact on microangiopathy but not macroangiopathy and its related morbidity and mortality. Thus, the therapeutic algorithm has shifted focus from a glucose-centered approach to a strategy that now emphasizes target-organ protection. Sodium-glucose transporter 2 inhibitors is an extremely important class of antidiabetic medications that, in addition to their glucose lowering effect, also exhibit cardio- and renoprotective effects. Various established and novel biomarkers have been described, reflecting kidney and cardiovascular function. In this review, we investigated the changes in established but also novel biomarkers of kidney, heart and vascular function associated with sodium-glucose transporter 2 inhibitors treatment in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Melpomeni Peppa
- Endocrine Unit, 2nd Propaedeutic Department of Internal Medicine, School of Medicine, Research Institute and Diabetes Center, Attikon University Hospital, National and Kapodistrian University of Athens, 12641 Athens, Greece; (A.M.); (I.M.)
- 3rd Department of Internal Medicine, School of Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.A.); (A.S.); (A.K.)
| | - Aspasia Manta
- Endocrine Unit, 2nd Propaedeutic Department of Internal Medicine, School of Medicine, Research Institute and Diabetes Center, Attikon University Hospital, National and Kapodistrian University of Athens, 12641 Athens, Greece; (A.M.); (I.M.)
| | - Ioanna Mavroeidi
- Endocrine Unit, 2nd Propaedeutic Department of Internal Medicine, School of Medicine, Research Institute and Diabetes Center, Attikon University Hospital, National and Kapodistrian University of Athens, 12641 Athens, Greece; (A.M.); (I.M.)
| | - Athina Asimakopoulou
- 3rd Department of Internal Medicine, School of Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.A.); (A.S.); (A.K.)
| | - Alexandros Syrigos
- 3rd Department of Internal Medicine, School of Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.A.); (A.S.); (A.K.)
| | - Constantinos Nastos
- 3rd Department of Surgery, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12641 Athens, Greece; (C.N.); (E.P.)
| | - Emmanouil Pikoulis
- 3rd Department of Surgery, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12641 Athens, Greece; (C.N.); (E.P.)
| | - Anastasios Kollias
- 3rd Department of Internal Medicine, School of Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.A.); (A.S.); (A.K.)
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Luo J, Hendryx M, Dong Y. Sodium-glucose cotransporter 2 (SGLT2) inhibitors and non-small cell lung cancer survival. Br J Cancer 2023; 128:1541-1547. [PMID: 36765176 PMCID: PMC10070339 DOI: 10.1038/s41416-023-02177-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 01/09/2023] [Accepted: 01/20/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a relatively new class of antidiabetic drugs with demonstrated renal and cardiovascular disease benefit. This study evaluates the role of SGLT2 inhibitors on the survival of non-small cell lung cancer (NSCLC) patients. METHODS We used National Surveillance, Epidemiology and End Results (SEER)-Medicare linked data. Twenty four thousand nine hundred fifteen NSCLC patients newly diagnosed between 2014 and 2017 with pre-exiting diabetes and aged 66 years or older were included and followed to the end of 2019. Information on SGLT2 inhibitors use was extracted from the Medicare Part D file. RESULTS SGLT2 inhibitor use was associated with significantly reduced mortality risk after adjusting for potential confounders (HR = 0.68, 95% CI = 0.60-0.77) with stronger association for longer duration of use (HR = 0.54, 85% CI = 0.44-0.68). Further, we found that SGLT2 inhibitor use was associated with a significant reduced risk of mortality regardless of patients' demographic, tumour characteristics and cancer treatments. CONCLUSION Our large SEER-Medicare linked data study indicates that SGLT2 inhibitors use was associated with improved overall survival of NSCLC patients with pre-existing diabetes. Further studies are needed to confirm our findings and elucidate the possible mechanisms behind the association.
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Affiliation(s)
- Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA.
| | - Michael Hendryx
- Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Yi Dong
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
- Division of Hematology Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Hendryx M, Dong Y, Ndeke JM, Luo J. Sodium-glucose cotransporter 2 (SGLT2) inhibitor initiation and hepatocellular carcinoma prognosis. PLoS One 2022; 17:e0274519. [PMID: 36094949 PMCID: PMC9467321 DOI: 10.1371/journal.pone.0274519] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a relatively new class of antidiabetic drugs. Emerging findings from laboratory studies indicate that SGLT2 inhibitors can improve liver function and suppress the proliferation of hepatocellular carcinoma (HCC) cells. The aim of this study was to test the hypothesis that initiation of SGLT2 inhibitors improves HCC prognosis in a human population.
Methods
We used National Surveillance, Epidemiology and End Results (SEER)—Medicare linked data in the United States to evaluate the role of SGLT2 inhibitor initiation on the survival of HCC patients. 3,185 HCC patients newly diagnosed between 2014 and 2017 aged 66 years or older with pre-existing type 2 diabetes were included and followed to the end of 2019. Information on SGLT2 inhibitor initiation was extracted from the Medicare Part D file.
Results
SGLT2 inhibitor initiation was associated with significantly lower mortality risk after adjusting for potential confounders (HR = 0.68, 95% CI = 0.54–0.86) with stronger association for longer duration of use (HR = 0.60, 95% CI = 0.41–0.88). Further, we found that SGLT2 inhibitor initiation was associated with a lower risk mortality risk ranging from 14% to 60% regardless of patient demographic variables, tumor characteristics, and cancer treatments.
Conclusion
Our large SEER-Medicare linked data study indicates that SGLT2 inhibitor initiation was associated with improved overall survival of HCC patients with pre-existing type 2 diabetes compared with no SGLT2 inhibitor use. Further studies are needed to confirm our findings and elucidate the possible mechanisms behind the association.
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Affiliation(s)
- Michael Hendryx
- Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, Indiana, United States of America
- * E-mail:
| | - Yi Dong
- Indiana University Simon Cancer Center, Indianapolis, Indiana, United States of America
- Division of Hematology Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Jonas M. Ndeke
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana, United States of America
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana, United States of America
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Canagliflozin Inhibits Human Endothelial Cell Inflammation through the Induction of Heme Oxygenase-1. Int J Mol Sci 2022; 23:ijms23158777. [PMID: 35955910 PMCID: PMC9369341 DOI: 10.3390/ijms23158777] [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] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Sodium-glucose co-transporter 2 (SGLT2) inhibitors improve cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM). Studies have also shown that canagliflozin directly acts on endothelial cells (ECs). Since heme oxygenase-1 (HO-1) is an established modulator of EC function, we investigated if canagliflozin regulates the endothelial expression of HO-1, and if this enzyme influences the biological actions of canagliflozin in these cells. Treatment of human ECs with canagliflozin stimulated a concentration- and time-dependent increase in HO-1 that was associated with a significant increase in HO activity. Canagliflozin also evoked a concentration-dependent blockade of EC proliferation, DNA synthesis, and migration that was unaffected by inhibition of HO-1 activity and/or expression. Exposure of ECs to a diabetic environment increased the adhesion of monocytes to ECs, and this was attenuated by canagliflozin. Knockdown of HO-1 reduced the anti-inflammatory effect of canagliflozin which was restored by bilirubin but not carbon monoxide. In conclusion, this study identified canagliflozin as a novel inducer of HO-1 in human ECs. It also found that HO-1-derived bilirubin contributed to the anti-inflammatory action of canagliflozin, but not the anti-proliferative and antimigratory effects of the drug. The ability of canagliflozin to regulate HO-1 expression and EC function may contribute to the clinical profile of the drug.
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Kwon CH, Kim YJ, Kim MJ, Cha MJ, Cho MS, Nam GB, Choi KJ, Kim J. Effect of Sodium-Glucose Cotransporter Inhibitors on Major Adverse Cardiovascular Events and Hospitalization for Heart Failure in Patients With Type 2 Diabetes Mellitus and Atrial Fibrillation. Am J Cardiol 2022; 178:35-42. [PMID: 35810007 DOI: 10.1016/j.amjcard.2022.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 02/07/2023]
Abstract
Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to lower cardiovascular morbidity and mortality in patients with type 2 diabetes mellitus (T2DM) and high cardiovascular risks. Here, we aimed to evaluate the effect of SGLT2 inhibitors on major adverse cardiovascular events (MACE), a composite of cardiovascular mortality, myocardial infarction, or ischemic stroke and hospitalization for heart failure in patients with T2DM and atrial fibrillation (AF). Using the Korean National Health Insurance Service database, we identified 40,268 patients with T2DM and AF who were newly prescribed oral hypoglycemic drugs (2,977 patients with SGLT2 inhibitors and 37,291 patients without SGLT2 inhibitors) between 2014 and 2018. After 1: 4 propensity score matching, patients who received SGLT2 inhibitors (n = 2,958) and those who did not receive SGLT2 inhibitors (n = 10,691) were enrolled, and followed up until December 31, 2018. During a mean follow-up duration of 2.1 ± 1.4 years, the risk of major adverse cardiovascular events was similar between the 2 groups (hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.76 to 1.21). There were no significant differences between the 2 groups for cardiovascular mortality, myocardial infarction, or ischemic stroke. However, patients who received SGLT2 inhibitors had significantly lower risks of hospitalization for heart failure (HR 0.70, 95% CI 0.53 to 0.93) and all-cause mortality (HR 0.74, 95% CI 0.56 to 0.98) than those who did not receive SGLT2 inhibitors. In conclusion, in this real-world cohort of Asian patients with T2DM and AF, use of SGLT2 inhibitors was associated with a lower risk of hospitalization for heart failure.
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Affiliation(s)
- Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Ju Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myung-Jin Cha
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Soo Cho
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Byoung Nam
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee-Joon Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Durante W, Behnammanesh G, Peyton KJ. Effects of Sodium-Glucose Co-Transporter 2 Inhibitors on Vascular Cell Function and Arterial Remodeling. Int J Mol Sci 2021; 22:ijms22168786. [PMID: 34445519 PMCID: PMC8396183 DOI: 10.3390/ijms22168786] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/20/2022] Open
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality in diabetes. Recent clinical studies indicate that sodium-glucose co-transporter 2 (SGLT2) inhibitors improve cardiovascular outcomes in patients with diabetes. The mechanism underlying the beneficial effect of SGLT2 inhibitors is not completely clear but may involve direct actions on vascular cells. SGLT2 inhibitors increase the bioavailability of endothelium-derived nitric oxide and thereby restore endothelium-dependent vasodilation in diabetes. In addition, SGLT2 inhibitors favorably regulate the proliferation, migration, differentiation, survival, and senescence of endothelial cells (ECs). Moreover, they exert potent antioxidant and anti-inflammatory effects in ECs. SGLT2 inhibitors also inhibit the contraction of vascular smooth muscle cells and block the proliferation and migration of these cells. Furthermore, studies demonstrate that SGLT2 inhibitors prevent postangioplasty restenosis, maladaptive remodeling of the vasculature in pulmonary arterial hypertension, the formation of abdominal aortic aneurysms, and the acceleration of arterial stiffness in diabetes. However, the role of SGLT2 in mediating the vascular actions of these drugs remains to be established as important off-target effects of SGLT2 inhibitors have been identified. Future studies distinguishing drug- versus class-specific effects may optimize the selection of specific SGLT2 inhibitors in patients with distinct cardiovascular pathologies.
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A Role for SGLT-2 Inhibitors in Treating Non-diabetic Chronic Kidney Disease. Drugs 2021; 81:1491-1511. [PMID: 34363606 DOI: 10.1007/s40265-021-01573-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 02/06/2023]
Abstract
In recent years, inhibitors of the sodium-glucose co-transporter 2 (SGLT2 inhibitors) have been shown to have significant protective effects on the kidney and the cardiovascular system in patients with diabetes. This effect is also manifested in chronic kidney disease (CKD) patients and is minimally due to improved glycaemic control. Starting from these positive findings, SGLT2 inhibitors have also been tested in patients with non-diabetic CKD or heart failure with reduced ejection fraction. Recently, the DAPA-CKD trial showed a significantly lower risk of CKD progression or death from renal or cardiovascular causes in a mixed population of patients with diabetic and non-diabetic CKD receiving dapagliflozin in comparison with placebo. In patients with heart failure and reduced ejection fraction, two trials (EMPEROR-Reduced and DAPA-HF) also found a significantly lower risk of reaching the secondary renal endpoint in those treated with an SGLT2 inhibitor in comparison with placebo. This also applied to patients with CKD. Apart from their direct mechanism of action, SGLT2 inhibitors have additional effects that could be of particular interest for patients with non-diabetic CKD. Among these, SGLT2 inhibitors reduce blood pressure and serum acid uric levels and can increase hemoglobin levels. Some safety issues should be further explored in the CKD population. SGLT2 inhibitors can minimally increase potassium levels, but this has not been shown by the CREDENCE trial. They also increase magnesium and phosphate reabsorption. These effects could become more significant in patients with advanced CKD and will need monitoring when these agents are used more extensively in the CKD population. Conversely, they do not seem to increase the risk of acute kidney injury.
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Muzurović E, Mikhailidis DP. Impact of glucagon-like peptide 1 receptor agonists and sodium-glucose transport protein 2 inhibitors on blood pressure and lipid profile. Expert Opin Pharmacother 2020; 21:2125-2135. [DOI: 10.1080/14656566.2020.1795132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Emir Muzurović
- Department of Internal Medicine, Endocrinology Section, Clinical Center of Montenegro, Podgorica, Montenegro
- University of Montenegro Faculty of Medicine, Podgorica, Montenegro
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
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Krasnova M, Kulikov A, Okovityi S, Ivkin D, Karpov A, Kaschina E, Smirnov A. Comparative efficacy of empagliflozin and drugs of baseline therapy in post-infarct heart failure in normoglycemic rats. Naunyn Schmiedebergs Arch Pharmacol 2020; 393:1649-1658. [PMID: 32377771 DOI: 10.1007/s00210-020-01873-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/14/2020] [Indexed: 12/12/2022]
Abstract
The study aimed to investigate the effects of the sodium-glucose co-transporter 2 (SGLT2) inhibitor empagliflozin on chronic heart failure (HF) in normoglycemic rats. The effects of empagliflozin were compared with the standard medications for HF, e.g., angiotensin-converting enzyme (ACE) inhibitor fosinopril, beta-blocker bisoprolol, and aldosterone antagonist spironolactone. Myocardial infarction (MI) was induced in male Wistar rats via permanent ligation of the left descending coronary artery. One-month post MI, 50 animals were randomized into 5 groups (n = 10): vehicle-treated, empagliflozin (1.0 mg/kg), fosinopril (10 mg/kg), bisoprolol (10 mg/kg), and spironolactone (20 mg/kg). All medications except empagliflozin were titrated within a month and administered per os daily for 3 months. Echocardiography, 24-hour urine volume test, and treadmill exercise tests were performed at the beginning and at the end of the study. Treatment with empagliflozin slowed the progression of left ventricular dysfunction: LV sizes and ejection fraction were not changed and the minute volume was significantly increased (from 52.0 ± 15.5 to 61.2 ± 21.2 ml/min) as compared with baseline. No deaths occurred in empagliflozin group. The 24-hour urine volume tends to be higher in empagliflozin and spironolactone groups than in vehicle and fosinopril group. Moreover, empagliflozin exhibited maximal physical exercise tolerance in comparison with all investigated groups (289 ± 27 s versus 183 ± 61 s in fosinopril group, 197 ± 95 s in bisoprolol group, and 47 ± 46 s in spironolactone group, p = 0.0035 for multiple comparisons). Sodium-glucose co-transporter 2 inhibitor empagliflozin reduced progression of left ventricular dysfunction and improved tolerance of physical exercise in normoglycemic rats with HF. Empagliflozin treatment was superior with respect to physical tolerance compared with fosinopril, bisoprolol, and spironolactone.
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Affiliation(s)
- Marina Krasnova
- Department of Pharmacology and Clinical Pharmacology, Center of Experimental Pharmacology Saint Petersburg Chemical Pharmaceutical University, Saint Petersburg, Russia.
| | - Alexander Kulikov
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Sergey Okovityi
- Department of Pharmacology and Clinical Pharmacology, Center of Experimental Pharmacology Saint Petersburg Chemical Pharmaceutical University, Saint Petersburg, Russia
| | - Dmitry Ivkin
- Department of Pharmacology and Clinical Pharmacology, Center of Experimental Pharmacology Saint Petersburg Chemical Pharmaceutical University, Saint Petersburg, Russia
| | - Andrey Karpov
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Elena Kaschina
- Charite Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin, Humboldt-Universitat zu Berlin and Berlin Institute of Health, German Centre for Cardiovascular Research, Berlin, Germany
| | - Alexey Smirnov
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
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Castellana M, Cignarelli A, Brescia F, Perrini S, Natalicchio A, Laviola L, Giorgino F. Efficacy and safety of GLP-1 receptor agonists as add-on to SGLT2 inhibitors in type 2 diabetes mellitus: A meta-analysis. Sci Rep 2019; 9:19351. [PMID: 31852920 PMCID: PMC6920368 DOI: 10.1038/s41598-019-55524-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/11/2019] [Indexed: 02/06/2023] Open
Abstract
GLP-1 receptor agonists (GLP-1RA) and SGLT2 inhibitors (SGLT2i) have been associated with improved glycemic control, body weight loss and favorable changes in cardiovascular risk factors and outcomes. We conducted a systematic review and meta-analysis to evaluate the effects of the addition of GLP-1RA to SGLT2i in patients with type 2 diabetes mellitus and inadequate glycemic control. Six databases were searched until March 2019. Randomized controlled trials (RCT) with a follow-up of at least 24 weeks reporting on HbA1c, body weight, systolic blood pressure, lipids, achievement of HbA1c < 7%, requirement of rescue therapy due to hyperglycemia and hypoglycemic events were selected. Four RCTs were included. Compared to SGLT2i, the GLP-1RA/SGLT2i combination was associated with greater reduction in HbA1c (-0.74%), body weight (-1.61 kg), and systolic blood pressure (-3.32 mmHg). A higher number of patients achieved HbA1c < 7% (RR = 2.15), with a lower requirement of rescue therapy (RR = 0.37) and similar incidence of hypoglycemia. Reductions in total and LDL cholesterol were found. The present review supports treatment intensification with GLP-1RA in uncontrolled type 2 diabetes on SGLT2i. This drug regimen could provide improved HbA1c control, together with enhanced weight loss and blood pressure and lipids control.
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Affiliation(s)
- Marco Castellana
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Angelo Cignarelli
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Brescia
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Sebastio Perrini
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Annalisa Natalicchio
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Luigi Laviola
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy.
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12
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Exercise as A Potential Therapeutic Target for Diabetic Cardiomyopathy: Insight into the Underlying Mechanisms. Int J Mol Sci 2019; 20:ijms20246284. [PMID: 31842522 PMCID: PMC6940726 DOI: 10.3390/ijms20246284] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus is associated with cardiovascular, ophthalmic, and renal comorbidities. Among these, diabetic cardiomyopathy (DCM) causes the most severe symptoms and is considered to be a major health problem worldwide. Exercise is widely known as an effective strategy for the prevention and treatment of many chronic diseases. Importantly, the onset of complications arising due to diabetes can be delayed or even prevented by exercise. Regular exercise is reported to have positive effects on diabetes mellitus and the development of DCM. The protective effects of exercise include prevention of cardiac apoptosis, fibrosis, oxidative stress, and microvascular diseases, as well as improvement in cardiac mitochondrial function and calcium regulation. This review summarizes the recent scientific findings to describe the potential mechanisms by which exercise may prevent DCM and heart failure.
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Katsiki N, Mikhailidis DP. Iron absorption, bone marrow fat and hematopoiesis in heart failure: Additional mechanisms of action for sodium-glucose co-transporter 2 inhibitors (SGLT2i)? J Diabetes Complications 2019; 33:107408. [PMID: 31522962 DOI: 10.1016/j.jdiacomp.2019.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Niki Katsiki
- First Department of Internal Medicine, Division of Endocrinology and Metabolism, Diabetes Center, Medical School, AHEPA University Hospital, Thessaloniki, Greece.
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK
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Empagliflozin and Dulaglutide are Effective against Obesity-induced Airway Hyperresponsiveness and Fibrosis in A Murine Model. Sci Rep 2019; 9:15601. [PMID: 31666643 PMCID: PMC6821734 DOI: 10.1038/s41598-019-51648-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 09/26/2019] [Indexed: 02/07/2023] Open
Abstract
Patients with asthma with obesity experience severe symptoms, are unresponsive to conventional asthma treatment, and lack proper pharmacotherapy. Empagliflozin and dulaglutide, developed for diabetes, reduce weight, decrease insulin resistance, and exert additive effects. We evaluated the efficacy of empagliflozin, dulaglutide, and their combination on obesity-induced airway hyperresponsiveness (AHR) and lung fibrosis using a murine model. We assigned C57BL/6J mice to five groups: control, high-fat diet (HFD), and HFD with empagliflozin, dulaglutide, or both. Mice received a 12-week HFD, empagliflozin (5 days/week, oral gavage), and dulaglutide (once weekly, intraperitoneally). Both drugs significantly attenuated HFD-induced weight increase, abnormal glucose metabolism, and abnormal serum levels of leptin and insulin, and co-treatment was more effective. Both drugs significantly alleviated HFD-induced AHR, increased macrophages in bronchoalveolar lavage fluid (BALF), and co-treatment was more effective on AHR. HFD-induced lung fibrosis was decreased by both drugs alone and combined. HFD induced interleukin (IL)-17, transforming growth factor (TGF)-β1, and IL-1β mRNA and protein expression, which was significantly reduced by empagliflozin, dulaglutide, and their combination. Tumour necrosis factor (TNF)-α and IL-6 showed similar patterns without significant differences. HFD-enhanced T helper (Th) 1 and Th17 cell differentiation was improved by both drugs. Empagliflozin and dulaglutide could be a promising therapy for obesity-induced asthma and showed additive effects in combination.
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Shao SC, Chang KC, Hung MJ, Yang NI, Chan YY, Chen HY, Kao Yang YH, Lai ECC. Comparative risk evaluation for cardiovascular events associated with dapagliflozin vs. empagliflozin in real-world type 2 diabetes patients: a multi-institutional cohort study. Cardiovasc Diabetol 2019; 18:120. [PMID: 31551068 PMCID: PMC6760106 DOI: 10.1186/s12933-019-0919-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/21/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND To compare the cardiovascular event risk in type 2 diabetes patients newly receiving dapagliflozin vs. empagliflozin. METHODS We conducted a retrospective cohort study by analyzing a multi-institutional electronic medical records database (Chang Gung Research Database) in Taiwan and included adult type 2 diabetes patients who were newly receiving sodium-glucose co-transporter 2 (SGLT2) inhibitors from 2016 to 2017. The primary outcome was a composite of cardiovascular death, myocardial infarction, ischemic stroke and heart failure. We followed up patients from initiation of SGLT2 inhibitors until the occurrence of cardiovascular events before December 31, 2018. We performed multivariable Cox proportional hazard modeling, adjusting for patients' age, sex, laboratory data, co-morbidities, and concomitant medications. RESULTS We identified 12,681 new SGLT2 inhibitor users with a mean age of 58.9 (SD 11.8) years, of whom 43.9% were female and 45.8% were new dapagliflozin users. A total of 10,442 person-years of dapagliflozin use and 12,096 person-years of empagliflozin use were included. Compared to empagliflozin users, new users of dapagliflozin were found to have similar risks for primary composite outcome (adjusted HR: 0.91; 95% CI 0.73-1.14), cardiovascular death (adjusted HR: 0.54; 95% CI 0.14-2.12), myocardial infarction (adjusted HR: 0.77, 95% CI 0.49-1.19) and ischemic stroke (adjusted HR: 1.15; 95% CI 0.80-1.65), but a lower risk of heart failure (adjusted HR: 0.68; 95% CI 0.49-0.95). CONCLUSION The risk of cardiovascular events was similar between dapagliflozin and empagliflozin new users, but dapagliflozin may have a better outcome in the reduction of heart failure in type 2 diabetes patients. Future prospective studies are required to confirm the findings.
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Affiliation(s)
- Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 701 Taiwan
| | - Kai-Cheng Chang
- Department of Pharmacy, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Jui Hung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ning-I Yang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yuk-Ying Chan
- Department of Pharmaceutical Materials Management, Chang Gung Medical Foundation, Taoyuan, Taiwan
| | - Hui-Yu Chen
- Department of Pharmacy, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yea-Huei Kao Yang
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 701 Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 701 Taiwan
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Rambaran K, Pinto Pereira L, Teelucksingh S. Sodium-glucose cotransporter 2 inhibition as a potential treatment for idiopathic oedema. Med Hypotheses 2019; 130:109270. [PMID: 31383344 DOI: 10.1016/j.mehy.2019.109270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 06/09/2019] [Indexed: 11/30/2022]
Abstract
Idiopathic oedema is a syndrome affecting primarily women that is characterized by frustrating intermittent fluid retention, with hallmarks of obesity, periodic oedema, anxiety, and a susceptibility to develop type 2 diabetes. Management is typically reassurance and weight control, with no known drug class proven to provide consistent relief. We hypothesise that sodium-glucose cotransporter 2 inhibition is a logical intervention in the treatment of idiopathic oedema, having effects on obesity, blood pressure, impaired glucose tolerance, sympathetic overdrive, and reduction in swelling - the most common and distressing complaint. Sodium-glucose cotransporter 2 inhibition by promoting greater electrolyte-free, but glucose driven, water clearance with preferential fluid clearance from the interstitial space, without compromising intravascular volume, may provide symptomatic relief of swelling and bloating. The consequent weight reduction secondary to caloric loss from renal glycosuria and decreased adiposity would prevent disease progression of type 2 diabetes or pre-diabetes. With diminished adrenergic output from central and peripheral autonomic influences, reduction of blood pressure occurs, and by similar mechanisms, anxiety may be reduced.
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Affiliation(s)
- Kirin Rambaran
- Department of Internal Medicine, Medical Associates Hospital, Corner of Albert and Abercromby Streets, St Joseph, Trinidad and Tobago
| | - Lexley Pinto Pereira
- Faculty of Medical Sciences, The University of the West Indies, Eric Williams Medical Sciences Complex, Mount Hope, Trinidad and Tobago; Department of Internal Medicine, Medical Associates Hospital, Corner of Albert and Abercromby Streets, St Joseph, Trinidad and Tobago
| | - Surujpal Teelucksingh
- Faculty of Medical Sciences, The University of the West Indies, Eric Williams Medical Sciences Complex, Mount Hope, Trinidad and Tobago; Department of Internal Medicine, Medical Associates Hospital, Corner of Albert and Abercromby Streets, St Joseph, Trinidad and Tobago.
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Shahady E, Leahy JL. Sodium-Glucose Cotransporter 2 Inhibitor Protection Against Adverse Cardiovascular and Renal Outcomes in Patients With Type 2 Diabetes. Clin Diabetes 2019; 37:211-220. [PMID: 31371851 PMCID: PMC6640890 DOI: 10.2337/cd18-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
IN BRIEF New treatments for type 2 diabetes are required to demonstrate cardiovascular safety in dedicated cardiovascular outcomes trials (CVOTs). This article reviews available evidence on cardiovascular, renal, and safety outcomes from CVOTs and real-world analyses of sodium-glucose cotransporter 2 inhibitors, along with considerations for their use in clinical practice.
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Affiliation(s)
| | - John L. Leahy
- University of Vermont College of Medicine, Burlington, VT
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18
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Rabizadeh S, Nakhjavani M, Esteghamati A. Cardiovascular and Renal Benefits of SGLT2 Inhibitors: A Narrative Review. Int J Endocrinol Metab 2019; 17:e84353. [PMID: 31372172 PMCID: PMC6628616 DOI: 10.5812/ijem.84353] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 02/27/2019] [Accepted: 03/03/2019] [Indexed: 02/06/2023] Open
Abstract
CONTEXT Most recently developed anti-hyperglycemic drugs have offered cardiovascular and renal benefits. In this narrative review, we discuss the cardiovascular and renal benefits of novel antidiabetic drugs, sodium glucose cotransporter type 2 (SGLT2) inhibitors, in type 2 diabetes. EVIDENCE ACQUISITION The literature published in PubMed, Scopus, Web of Science, Google Scholar, and Cochrane library were reviewed up to January 2019. The keywords including SGLT2 inhibitor, type 2 diabetes, cardiovascular effect, and renal effect were used in different combinations. RESULTS Cardiovascular disease represents a large health burden in patients with diabetes. The prevention of cardiovascular events is a major concern in the treatment of patients with diabetes. Diabetes is also associated with an increased risk of adverse renal events and diabetic nephropathy is the leading cause of end-stage renal disease worldwide. SGLT2 inhibitors as new glucose-lowering agents act by inhibiting glucose reabsorption in the proximal tubule of the kidney, which is independent of insulin secretion. We reviewed the cardiovascular effects of these drugs including effects on triple MACE (major adverse cardiovascular events), myocardial infarction, heart failure, cardiovascular and all-cause mortality, and stroke, as well as renal effects including albuminuria, serum creatinine, the rate of renal replacement therapy, and renal function over time, along with the mechanisms of these effects. CONCLUSIONS Given the suboptimal glycemic and cardiovascular risk control in type 2 diabetes, novel therapies such as SGLT2 inhibitors seem to have an important clinical advantage to improve glycemic control and cardiovascular and renal outcomes.
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Affiliation(s)
- Soghra Rabizadeh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Zhao D, Liu H, Dong P. Empagliflozin reduces blood pressure and uric acid in patients with type 2 diabetes mellitus: a systematic review and meta-analysis. J Hum Hypertens 2018; 33:327-339. [PMID: 30443007 DOI: 10.1038/s41371-018-0134-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 10/24/2018] [Accepted: 10/29/2018] [Indexed: 12/14/2022]
Abstract
The antidiabetic effect of empagliflozin in patients with type 2 diabetes mellitus has been explored in several trials. We performed this meta-analysis determining the effects of empagliflozin on blood pressure, uric acid, estimated glomerular filtration rate, blood lipids, blood glucose, and body weight in patients with type 2 diabetes mellitus. We searched three electronic databases (Pubmed, Web of Science, and Cochrane Central) for all published articles evaluating the effects of empagliflozin on blood glucose or blood pressure in subjects with type 2 diabetes mellitus. Total 5781 patients were included in 12 randomized controlled trials with a follow-up of 28 ± 22 weeks. Empagliflozin 10 or 25 mg reduced systolic and diastolic blood pressure, uric acid, hemoglobin A1c, fasting plasma glucose, and body weight in patients with type 2 diabetes mellitus (all p < 0.001). There were no differences for changes of estimated glomerular filtration rate between empagliflozin 10 or 25 mg and placebo in these patients (all p > 0.05). In conclusion, empagliflozin reduces systolic and diastolic blood pressure, uric acid, hemoglobin A1c, fasting plasma glucose, and body weight. These data suggest the beneficial effects of empagliflozin on these cardiovascular risk factors in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Di Zhao
- Division of Hypertension, the First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, 471003, China.
| | - Hui Liu
- Division of Endocrinology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, 471000, China
| | - Pingshuan Dong
- Division of Cardiology, the First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, 471003, China
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Filippas-Ntekouan S, Tsimihodimos V, Filippatos T, Dimitriou T, Elisaf M. SGLT-2 inhibitors: pharmacokinetics characteristics and effects on lipids. Expert Opin Drug Metab Toxicol 2018; 14:1113-1121. [DOI: 10.1080/17425255.2018.1541348] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
| | - Vasilios Tsimihodimos
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Theodosios Filippatos
- Department of Internal Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Theodora Dimitriou
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Moses Elisaf
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
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