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AlFil S, Khadhim F, Miahy S, Agar R, Catapano AL, Arca M, Averna M, Calandra S, Tarugi P, Casula M, Galimberti F, Olmastroni E, Sarzani R, Ferri C, Repetti E, Piro S, Suppressa P, Meregalli G, Borghi C, Muntoni S, Calabrò P, Cipollone F, Purrello F, Pujia A, Passaro A, Marcucci R, Pecchioli V, Pisciotta L, Mandraffino G, Pellegatta F, Mombelli G, Branchi A, Fiorenza AM, Pederiva C, Werba JP, Parati G, Carubbi F, Iughetti L, Fortunato G, Iannuzzi A, Iannuzzo G, Cefalù AB, Biasucci G, Zambon S, Pirro M, Sbrana F, Trenti C, D'Erasmo L, Federici M, Ben MD, Bartuli A, Giaccari A, Pipolo A, Citroni N, Guardamagna O, Lia S, Benso A, Biolo G, Maroni L, Lupi A, Bonanni L, Rinaldi E, Zenti MG, Matsuki K, Hori M, Ogura M, Masuda D, Kobayashi T, Nagahama K, Al-Jarallah M, Radovic M, Lunegova O, Bektasheva E, Abilova S, Erglis A, Gilis D, Nesterovics G, Saripo V, Meiere R, Skudrina G, Terauda E, Jambart S, Ayoub C, Ghaleb Y, Aliosaitiene U, Kutkiene S, Abdul Kadir SHS, Kasim NAM, Nor NSM, Abdul Hamid H, Abdul Razak S, Al-Khateeb A, Abd Muid S, Abdul Rahman T, Kasim SS, Radzi ABM, Ibrahim KS, Rosli MM, Razali R, Chua YA, Razman AZ, Nazli SA, Aziz N, Rosman A, Abdul Murad N, Jalaludin MA, Abdul Latif AZ, Azzopardi C, Mehta R, Martagon AJ, Ramirez GAG, Villa NEA, Vazquez AV, Elias-Lopez D, Retana GG, Rodriguez B, Macías JJC, Zazueta AR, Alvarado RM, Portano JDM, Lopez HA, Sauque-Reyna L, Herrera LGG, Mendia LES, Aguilar HG, Cooremans ER, Aparicio BP, Zubieta VM, Gonzalez PAC, Ferreira-Hermosillo A, Portilla NC, Dominguez GJ, Garcia AYR, Cazares HEA, Gonzalez JR, Valencia CVM, Padilla FG, Prado RM, Ibarra MODLR, Villicaña RDA, Rivera KJA, Carrera RA, Alvarez JA, Martinez JCA, Bustillo MDLRB, Vargas GC, Chacon RC, Andrade MHF, Ortega AF, Alcala HG, de Leon LEG, Guzman BG, Garcia JJG, Cuellar JCG, Cruz JRG, Garcia AH, Almada JRH, Herrera UJ, Sobrevilla FL, Rodriguez EM, Sibaja CM, Rodriguez ABM, Oyervides JCM, Vazquez DIP, Rodriguez EAR, Osorio MLR, Saucedo JR, Tamayo MT, Talavera LAV, Arroyo LEV, Carrillo EAZ, Stroes ES, Defesche J, Zuurbier L, Reeskamp L, Ibrahim S, Roeters van Lennep J, Wiegman A, Isara A, Obaseki DE, Al-Waili K, Al-Zadjali F, Al-Zakwani I, Al-Kindi M, Al-Mukhaini S, Al-Barwani H, Rana A, Shah LSU, Al-Nouri F, Starostecka E, Konopka A, Bielecka-Dabrowa A, Lewek J, Sosnowska B, Gąsior M, Dyrbuś K, Jóźwiak J, Pajkowski M, Romanowska-Kocejko M, Żarczyńska-Buchowiecka M, Chmara M, Wasąg B, Stróżyk A, Michalska-Grzonkowska A, Medeiros AM, Alves AC, Silva F, Lobarinhas G, Palma I, de Moura JP, Rico MT, Rato Q, Pais P, Correia S, Moldovan O, Virtuoso MJ, Araujo F, Salgado JM, Colaço I, Dumitrescu A, Lengher C, Mosteoru S, Meshkov A, Ershova A, Rozhkova T, Korneva V, Yu KT, Zafiraki V, Voevoda M, Gurevich V, Duplyakov D, Ragino Y, Chubykina U, Shaposhnik I, Alkaf F, Khudari A, Rwaili N, Al-Allaf F, Alghamdi M, Batais MA, Almigbal TH, Kinsara A, AlQudaimi AHA, Awan Z, Elamin OA, Altaradi H, Popovic L, Singh S, Rasulic I, Petakov A, Lalic NM, Lam C, Le TJ, Siang ELT, Dissanayake S, I-Shing JT, Shyong TE, Jin TCS, Ting SPL, Ming JHK, Drum CL, Nastar FA, Jia LW, Ya NKS, Jie MCW, Dalan R, Wei YQ, sian TY, Keong YK, Rong SK, Jin DSE, Ming IKJ, Chang TH, Peng FYK, Vasanwala RF, Raslova K, Balinth K, Buganova I, Fabryova L, Kadurova M, Klabnik A, Kozárová M, Sirotiakova J, Battelino T, Cevc M, Debeljak M, Torkar AD, Fras Z, Jug B, Cugalj BK, Kovac J, Mlinaric M, Sikonja J, Pilcher GJ, Blom DJ, Wolmarans KH, Brice BC, Muñiz-Grijalvo O, Díaz-Díaz JL, de Isla LP, Fuentes F, Badimon L, Martin F, Miserez EB, Shipton JL, Ganokroj P, Chattranukulchai P, Jiamjarasrungsi W, Thongtang N, Krittayaphong R, Vathesatogkit P, Sriphrapradang C, Phimphilai M, Leelawattana R, Anthanont P, Suraamornkul S, Deerochanawong C, Senthong V, Torpongpun A, Suteerayongprasert P, Pengpong N, Sathavarodom N, Sunanta U, Porntharukchareon T, Kiatpanabhikul P, Kaewkrasaesin C, Kongkit J, Umphonsathien M, Akbulut M, Alici G, Bayram F, Can LH, Celik A, Ceyhan C, Coskun FY, Demir M, Demircan S, Dogan V, Durakoglugil E, Dural İE, Gedikli O, Hacioglu A, Ildizli M, Kilic S, Kirilmaz B, Kutlu M, Oguz A, Ozdogan O, Onrat E, Ozer S, Sabuncu T, Sahin T, Sivri F, Sonmez A, Temizhan A, Topcu S, Tokgozoglu L, Tuncez A, Vural M, Yenercag M, Yesilbursa D, Yigit Z, Yildirim AB, Yildirir A, Yilmaz MB, Atallah B, Traina M, Sabbour H, Abdul Hay D, Luqman N, Elfatih A, Abdulrasheed A, Manla Y, Kwok S, DellOca N, Alieva RB, Fozilov KG, Hoshimov SU, Nizamov UI, Kan LE, Kim AR, Abdullaeva GJ, Abdullaev AA, Do DL, Nguyen MNT, Kim NT, Le TT, Le HA, Ray KK. Association of BMI, lipid-lowering medication, and age with prevalence of type 2 diabetes in adults with heterozygous familial hypercholesterolaemia: a worldwide cross-sectional study. Lancet Diabetes Endocrinol 2024; 12:811-823. [PMID: 39374602 DOI: 10.1016/s2213-8587(24)00221-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 07/05/2024] [Accepted: 07/15/2024] [Indexed: 10/09/2024]
Abstract
BACKGROUND Statins are the cornerstone treatment for patients with heterozygous familial hypercholesterolaemia but research suggests it could increase the risk of type 2 diabetes in the general population. A low prevalence of type 2 diabetes was reported in some familial hypercholesterolaemia cohorts, raising the question of whether these patients are protected against type 2 diabetes. Obesity is a well known risk factor for the development of type 2 diabetes. We aimed to investigate the associations of known key determinants of type 2 diabetes with its prevalence in people with heterozygous familial hypercholesterolaemia. METHODS This worldwide cross-sectional study used individual-level data from the EAS FHSC registry and included adults older than 18 years with a clinical or genetic diagnosis of heterozygous familial hypercholesterolaemia who had data available on age, BMI, and diabetes status. Those with known or suspected homozygous familial hypercholesterolaemia and type 1 diabetes were excluded. The main outcome was prevalence of type 2 diabetes overall and by WHO region, and in relation to obesity (BMI ≥30·0 kg/m2) and lipid-lowering medication as predictors. The study population was divided into 12 risk categories based on age (tertiles), obesity, and receiving statins, and the risk of type 2 diabetes was investigated using logistic regression. FINDINGS Among 46 683 adults with individual-level data in the FHSC registry, 24 784 with heterozygous familial hypercholesterolaemia were included in the analysis from 44 countries. 19 818 (80%) had a genetically confirmed diagnosis of heterozygous familial hypercholesterolaemia. Type 2 diabetes prevalence in the total population was 5·7% (1415 of 24 784), with 4·1% (817 of 19 818) in the genetically diagnosed cohort. Higher prevalence of type 2 diabetes was observed in the Eastern Mediterranean (58 [29·9%] of 194), South-East Asia and Western Pacific (214 [12·0%] of 1785), and the Americas (166 [8·5%] of 1955) than in Europe (excluding the Netherlands; 527 [8·0%] of 6579). Advancing age, a higher BMI category (obesity and overweight), and use of lipid-lowering medication were associated with a higher risk of type 2 diabetes, independent of sex and LDL cholesterol. Among the 12 risk categories, the probability of developing type 2 diabetes was higher in people in the highest risk category (aged 55-98 years, with obesity, and receiving statins; OR 74·42 [95% CI 47·04-117·73]) than in those in the lowest risk category (aged 18-38 years, without obesity, and not receiving statins). Those who did not have obesity, even if they were in the upper age tertile and receiving statins, had lower risk of type 2 diabetes (OR 24·42 [15·57-38·31]). The corresponding results in the genetically diagnosed cohort were OR 65·04 (40·67-104·02) for those with obesity in the highest risk category and OR 20·07 (12·73-31·65) for those without obesity. INTERPRETATION Adults with heterozygous familial hypercholesterolaemia in most WHO regions have a higher type 2 diabetes prevalence than in Europe. Obesity markedly increases the risk of diabetes associated with age and use of statins in these patients. Our results suggest that heterozygous familial hypercholesterolaemia does not protect against type 2 diabetes, hence managing obesity is essential to reduce type 2 diabetes in this patient population. FUNDING Pfizer, Amgen, MSD, Sanofi-Aventis, Daiichi-Sankyo, and Regeneron.
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Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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