scholarly journals Impact of Canagliflozin in Patients with Type 2 Diabetes after Hospitalization for Acute Heart Failure: A Cohort Study

2021 ◽  
Vol 10 (3) ◽  
pp. 505
Author(s):  
Ernesto Martín ◽  
José López-Aguilera ◽  
Rafael González-Manzanares ◽  
Manuel Anguita ◽  
Guillermo Gutiérrez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Cardiovascular Death ◽  
Sglt2 Inhibitors ◽  
Control Group ◽  
First Year ◽  
Cardiovascular Morbidity And Mortality ◽  
Patients With Diabetes

Background: Heart failure (HF) is one of the mayor contributors to cardiovascular morbidity and mortality in patients with diabetes. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated to reduce the risk of hospitalization for HF in patients with type 2 diabetes mellitus (T2D). We aimed to assess the risk for re-hospitalization in a cohort of patients hospitalized for HF according to whether or not they received canagliflozin at discharge, as well as changes in N-terminal pro–B-type natriuretic peptide (NT-ProBNP) concentration during follow-up. Methods: We conducted a retrospective longitudinal study at a tertiary centre including 102 consecutive T2D patients discharged for acute HF without contraindication for SGLT2 inhibitors. We compared adverse clinical events (HF rehospitalization and cardiovascular death) and NT-ProBNP changes according to canagliflozin prescription at discharge. Results: Among the 102 patients included, 45 patients (44.1%) were prescribed canagliflozin and the remaining 57 (55.9%) were not prescribed any SGLT2 inhibitors (control group). After a median follow-up of 22 months, 45 patients (44.1%) were hospitalized for HF. Most of the rehospitalizations occurred during the first year (37.3%). HF readmission at first year occurred in 10 patients (22.2%) in the canagliflozin group and 29 patients (49.1%) in the control group (hazard ratio (HR): 0.45; 95% confidence interval (CI): 0.21–0.96; p < 0.039). A composite outcome of hospitalization for HF or death from cardiovascular causes was lower in the canagliflozin group (37.8%) than in the control group (70.2%) (HR: 0.51; 95% CI: 0.27–0.95; p < 0.035). Analysis of NT-ProBNP concentration showed an interaction between canagliflozin therapy and follow-up time (p = 0.002). Conclusions: Canagliflozin therapy at discharge was associated with a lower risk of readmission for HF and a reduction in NT-ProBNP concentration in patients with diabetes after hospitalization for HF.

scholarly journals Benefit of Canagliflozin In Patients With Type 2 Diabetes After Hospitalization For Acute Heart Failure

2020 ◽  
Author(s):  
Ernesto Martin Dorado ◽  
José López-Aguilera ◽  
Rafael González ◽  
Manuel Anguita ◽  
Guillermo Gutiérrez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Acute Heart Failure ◽  
Sglt2 Inhibitors ◽  
Control Group ◽  
First Year ◽  
Cardiovascular Morbidity And Mortality ◽  
Patients With Diabetes

Abstract BACKGROUND: Heart failure (HF) is one of the mayor contributors to cardiovascular morbidity and mortality in patients with diabetes. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated to reduce the risk of hospitalization for HF in patients with type 2 diabetes mellitus. We aimed to compare the incidence of readmission in patients who received canagliflozin at discharge after hospitalization of acute HF and changes in N-terminal pro–B-type natriuretic peptide (NT-ProBNP) concentration during follow-up. METHODS: We retrospectively included 102 consecutive patients with diabetes discharged for acute heart failure and without contraindications for SGLT2 inhibitors. We divided them in two groups: 45 patients with canagliflozin at discharge therapy and 57 without any SGLT2 inhibitors.RESULTS: Over a median follow-up of 22 months, 45 (44.1%) were hospitalized for HF. Most of the patients who were readmitted due to heart failure occurred during the first year (37.3%). HF readmission at first year occurred in 10 patients (22.2%) in canagliflozin group and 29 patients (49.1%) in control group (HR: 0.45; 95% CI: 0.21–0.96; p < 0.039) after multivariate adjustment. A composite outcome of hospitalization for HF or death for cardiovascular causes was lower in canagliflozin group (37.8%) than in the control group (70.2%) (HR: 0.51; 95% CI: 0.27–0.95; p < 0.035). Analysis of NT-ProBNP concentration showed an interaction between canagliflozin therapy and follow-up time (p=0.002).CONCLUSIONS: Canagliflozin therapy at discharge was associated with lower risk of readmission for HF and a reduction of NT-ProBNP concentration in patients with diabetes after hospitalization for HF.

Sex-specific pattern of left ventricular hypertrophy and diastolic function in patients with type 2 diabetes mellitus

2020 ◽  
Author(s):  
Mei-Zhen Wu ◽  
Yan Chen ◽  
Yu-Juan Yu ◽  
Zhe Zhen ◽  
Ying-Xian Liu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Specific Pattern

Abstract Aims  Few prospective studies have evaluated sex-specific pattern, natural progression of left ventricular (LV) remodelling, and diastolic dysfunction in patients with type 2 diabetes (T2DM). The aim of this study was to study the sex-specific prevalence, longitudinal changes of LV remodelling, and diastolic dysfunction in patients with T2DM. Further, the prognostic value of diastolic function in women and men was also evaluated. Methods and results  A total of 350 patients with T2DM (mean age 61 ± 11 years; women, 48.3%) was recruited. Detailed echocardiography was performed at baseline and after 25 months. A major adverse cardiovascular event (MACE) was defined as cardiovascular death, heart failure hospitalization, or myocardial infarction. Despite a similar age, prevalence of hypertension and body mass index, women had a higher prevalence of LV hypertrophy and diastolic dysfunction at baseline and follow-up compared with men. A total of 21 patients developed MACE (5 cardiovascular death, 9 hospitalization for heart failure, and 7 myocardial infarction) during a median follow-up of 56 months. Women with diastolic dysfunction had a higher incidence of MACE than those with normal diastolic function but this association was neutral in men. Multivariable Cox-regression analysis indicated that diastolic dysfunction was associated with MACE in women [hazard ratio = 6.30; 95% confidence interval (CI) = 1.06–37.54; P &lt; 0.05] but not men (hazard ratio = 2.29, 95% CI = 0.67–7.89; P = 0.19). Conclusion  LV hypertrophy and diastolic dysfunction, both at baseline and follow-up, were more common in women than men. Pre-clinical diastolic dysfunction was independently associated with MACE only in women with T2DM but was neutral in men.

scholarly journals Treatment of Heart Failure with Sodium-Glucose Cotransporter 2 Inhibitors and Other Anti-diabetic Drugs

2019 ◽  
Vol 5 (1) ◽  
pp. 27-30 ◽  
Author(s):  
Thomas A Zelniker ◽  
Eugene Braunwald
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Renal Failure ◽  
Cardiovascular Death ◽  
Cardiovascular Outcomes ◽  
Sodium Glucose Cotransporter ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Glucagon Like Peptide 1

Patients with type 2 diabetes are at increased risk of developing heart failure, cardiovascular death and renal failure. The recent results of three large sodium-glucose cotransporter 2 inhibitor cardiovascular outcomes trials have demonstrated a reduction in heart failure hospitalisation and progressive renal failure. One trial also showed a fall in cardiovascular and total death. A broad spectrum of patients with diabetes benefit from these salutary effects in cardiac and renal function and so these trials have important implications for the management of patients with type 2 diabetes. Selected glucagon-like peptide 1 receptor agonists have also been shown to reduce adverse cardiovascular outcomes.

scholarly journals Comparative risk evaluation for cardiovascular events associated with dapagliflozin vs. empagliflozin in real-world type 2 diabetes patients: a multi-institutional cohort study

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Shih-Chieh Shao ◽  
Kai-Cheng Chang ◽  
Ming-Jui Hung ◽  
Ning-I Yang ◽  
Yuk-Ying Chan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Cardiovascular Events ◽  
Cardiovascular Death ◽  
Sglt2 Inhibitors ◽  
Diabetes Patients

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.

scholarly journals The risk of cardiovascular death in type 2 diabetes

2017 ◽  
Vol 95 (1) ◽  
pp. 57-59
Author(s):  
N. V. Zeinalova ◽  
Yagub Ziyaddin Kurbanov ◽  
V. A. Mirzazade ◽  
R. A. Rzayeva ◽  
M. S. Novruzova
Keyword(s):  
Type 2 Diabetes ◽  
Metabolic Disorders ◽  
Density Lipoprotein ◽  
Cardiovascular Death ◽  
Control Group ◽  
Average Risk ◽  
Virtual Control ◽  
Framingham Risk ◽  
Patients With Diabetes

Aim. To evaluate effects of metabolic disorders on the risk of cardiovascular death in patients with type II diabetes based on Framingham risk score. We analyzed results of examination of 210 men and 210 women with type 2 diabetes who applied for medical care to the VM center of Endocrinology during 1997-2014. A virtual control group was formed matching real patients in terms of the number, sex, age, and height having ideal body mass index, total cholesterol and high-density lipoprotein cholesterol levels. The average risk of cardiovascular death in patients with type 2 diabetes was equal to 4,56±0,254% compared with 0,6±1,028% in the virtual control group. The differences was significant (p <0,001). The minimum risk for the patients of the two groups was estimated at 0,001% and 0,01% respectively. The maximum risk of cardiovascular death is 34,17% in patients with diabetes and 8,24% in controls. It is concluded that type 2 diabetes and related metabolic disorders significantly increase the risk of cardiovascular death.

scholarly journals Effects of SGLT2 inhibitors on cardiovascular death and all-cause death in patients with type 2 diabetes and chronic kidney disease: an updated meta-analysis including the SCORED trial

2021 ◽  
Vol 12 ◽  
pp. 204201882110449
Author(s):  
Li-Min Zhao ◽  
Ze-Lin Zhan ◽  
Mei Qiu
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Cardiovascular Death ◽  
Sglt2 Inhibitors ◽  
Ckd Progression ◽  
Meta Analyses

Background: The effects of sodium-glucose transporter 2 (SGLT2) inhibitors on cardiovascular death (CV death) and all-cause death (AC death) in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) are currently under intensive investigation. We intended to conduct an updated meta-analysis including the SCORED trial to evaluate the effects of SGLT2 inhibitors on death and cardiorenal events in this vulnerable population. Methods: Cardiorenal outcome trials of SGLT2 inhibitors were included. Primary outcomes were CV death and AC death, while secondary outcomes were hospitalization for heart failure (HHF), myocardial infarction (MI), CKD progression, cardiovascular death or hospitalization for heart failure (CV death or HHF), major adverse cardiovascular events (MACE), and stroke. Meta-analysis was conducted for each outcome. Results: Eight trials were included for meta-analysis. Compared with placebo, SGLT2 inhibitors significantly lowered the risk of CV death (HR = 0.86, 95% CI = 0.75–0.98), AC death (HR = 0.87, 95% CI = 0.79–0.96), HHF (HR = 0.64, 95% CI = 0.56–0.74), MI (HR = 0.76, 95% CI = 0.65–0.89), CKD progression (HR = 0.62, 95% CI = 0.54–0.72), and CV death or HHF (HR = 0.73, 95% CI = 0.67–0.80). No heterogeneity existed in the above meta-analyses (all I2 values = 0%), whereas moderate heterogeneity existed in the meta-analyses for MACE and stroke (I2 = 31.6% and 44.5%, respectively). Conclusions: Our findings suggest that SGLT2 inhibitors versus placebo significantly lower death, heart failure, renal failure, and MI events in patients with T2D and CKD. Head-to-head trials are needed to examine the possible differences in the effects of various gliflozins on MACE and stroke.

scholarly journals Impact of canagliflozin in natriuretic peptides in patients with type 2 diabetes after hospitalization for acute heart failure

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Martin Dorado ◽  
R Gonzalez Manzanares ◽  
J.C Castillo Dominguez ◽  
J Lopez Aguilera ◽  
J Perea ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Ejection Fraction ◽  
Acute Decompensated Heart Failure ◽  
Signs And Symptoms ◽  
Sglt2 Inhibitors ◽  
Control Group ◽  
Dipeptidyl Peptidase 4 ◽  
Reduced Ejection Fraction

Abstract Background Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated to reduce the risk of hospitalization for heart failure (HF) in patients with type 2 diabetes mellitus (T2D). We aimed to assess the changes in N-terminal pro-B-type natriuretic peptide (NT-ProBNP) concentrations in a cohort of patients hospitalized for HF according to whether or not they received canagliflozin at discharge. Methods This cohort study included all patients with T2D admitted for HF from January 2017 to December 2019 in a single center. We excluded patients whose treatment with SGLT2 inhibitors were contraindicated (eGFR ≤45 ml/min/1.73 m2) and those who had other SGLT2 inhibitors than canagliflozin in their treatment at discharged. All patients had received a primary diagnosis of acute decompensated heart failure, including signs and symptoms of fluid overload and a concentration of NT-ProBNP of 1400 pg/mL at least. NT-ProBNP concentrations were collected at 3 months, 6 months, and 1 year after hospitalization with laboratory records if available. The aim of this study is to compare mean NT-ProBNP levels at hospital discharge and 3, 6 and 12 moths of follow-up in patients treated with and without canagliflozin. Results We included a total of 102 patients, 45 patients (44.1%) were prescribed canagliflozin and the remaining 57 (55.9%) were not prescribed any SGLT2 inhibitors (control group). There were no significant differences in clinical and comorbidities in both groups, except for age; slightly younger in the canagliflozin group (69,2±10,3 vs 73,2±11,1; p=0,04). Treatment at discharge was also similar, patients in the control group received more dipeptidyl peptidase-4 (DPP-4) inhibitors (21.1% vs 6.7%; p=0.04). Low rate of patients received sacubitril-valsartan (15,6%) in the canagliflozin group and 14% in the control group. More than a half of patients in both groups have HF with reduced ejection fraction. Mean levels of peptides were similar in both groups at hospital admission and discharge. During the first period of 3 months, we observed a decreased of NT-ProBNP concentration in both groups, but significantly inferior in canagliflozin group (p&lt;0,001). At 6 and 12 months, NT-ProBNP levels were practically maintained in patients treated with canagliflozin, whereas levels in patients in the control group were increased. Difference in both groups at a 12 month-period was significantly superior (p=0,004), with a median reduction of concentration levels at discharge of 64.3% in the canagliflozin group and 15,8% in control group. There were no differences in patients with HF from those with reduced ejection fraction and preserved. Conclusions Canagliflozin therapy at discharge was associated with a significant reduction in NT-ProBNP concentration in patients with diabetes after hospitalization for HF. FUNDunding Acknowledgement Type of funding sources: None. NT-ProBNP according to canagliflozin

scholarly journals Prognostic value of atherogenic index of plasma in patients with type 2 diabetes and acute coronary syndrome

2020 ◽  
Author(s):  
Le Wang ◽  
hongliang cong ◽  
Jingxia Zhang ◽  
Yuecheng Hu ◽  
Ao Wei ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Acute Coronary Syndrome ◽  
Prognostic Value ◽  
Cardiovascular Death ◽  
Mortality Prediction ◽  
Atherogenic Index ◽  
Coronary Syndrome ◽  
Patients With Diabetes

Abstract Background: Atherogenic index of plasm (AIP) has been identified as a risk factor for cardiovascular disease (CVD) and an independent predictor of mortality. However, it remains unknown whether AIP level may predict mortality in patients with diabetes and acute coronary syndrome (ACS). Methods: A total of 2531 consecutive patients with type 2 diabetes who underwent coronary angiography for ACS were enrolled in the study. Patients were divided into tertiles according to admission AIP level. The AIP was calculated as the base 10 logarithm of the ratio of the fating concentration of triglyceride (TG) to high-density lipoprotein-cholesterol (HDL-C). The primary endpoints were all-cause death and cardiovascular death. Multivariate cox hazard regression analysis were performed to calculate the hazard ratio(HR)and 95％confidence interval(CI)．C-statistics, continuous net reclassification improvement(NRI)，and integrated discrimination improvement(IDI) were calculated to evaluate the added prognostic value of AIP beyond the established mode for prediction of death．Results: During 3-year follow-up, all-cause death events occurred in 142 cases and cardiovascular death events occurred in 120 cases, respectively. The risk of all-cause death and cardiovascular death increased with AIP tertiles at a 3-year follow-up. The Kaplan-Meier curves showed that significant differences in event-free survival rates among AIP tertiles(all-cause mortality: p=0.006; cardiovascular mortality: p=0.003).Multivariate cox hazard regression analysis revealed that AIP was independently associated with all-cause death (HR: 3.859, 95% CI:1.926-7.734; p<0.001) and cardiovascular death (HR:4.723, 95% CI: 2.243-9.946; p<0.001). Addition of AIP to the established mode for mortality prediction was not associated with a significant improvement in the C-statistics value but there were significant improvements in reclassification for all-cause death (NRI: 0.198, p=0.022; IDI: 0.008, p=0.016) and cardiovascular death (NRI: 0.260, p=0.006; IDI: 0.010, p=0.021).Conclusions: Admission AIP was independently correlated with long-term mortality in patients with type 2 diabetes and ACS. These findings suggest that AIP may optimize the mortality prediction among patients with diabetes and ACS.

scholarly journals The Impact of SGLT2i Therapy on the Onset and Prognosis of Heart Failure in Patients with Type 2 Diabetes

2020 ◽  
Vol 2020 (1) ◽  
pp. 1
Author(s):  
Bogdan Timar ◽  
Adina Braha ◽  
Lucica Grigorică ◽  
Laura Gaiță ◽  
Romulus Timar
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Therapeutic Agents ◽  
Sglt2 Inhibitors ◽  
Major Adverse Cardiovascular Events ◽  
Patients With Diabetes ◽  
Cardioprotective Effects ◽  
New Generation ◽  
The Impact

The prevention of heart failure (HF) development in patients with diabetes mellitus (DM) represents one of the greatest challenges to date. Several studies have shown that targeting a very strict HbA1c does not reduce cardiovascular risk in type 2 diabetes (T2D) patients, concluding that there are additional factors that contribute to the risk of HF, as well as mechanisms possibly related to the therapeutic agents used to lower glycemic values. All these findings led to the reconsideration of T2D management. SGLT2 inhibitors (SGLT2i), a new generation of antihyperglycemic drugs, have gained the attention of cardiologists, since they proved cardioprotective effects by reducing three-point major adverse cardiovascular events (MACE) and heart failure hospitalizations in T2D patients. The mechanisms underlying the cardiovascular protection of SGLT2 inhibitors in T2D are complex and multifactorial, but not fully understood. This review discusses the onset and prognosis of heart failure in T2D patients treated with SGLT2 inhibitors.

scholarly journals Sodium-glucose co-transporter-2 inhibitors in patients with heart failure. What's new? What are the prospects?

2021 ◽  
Vol 23 (1) ◽  
pp. 48-51
Author(s):  
Alexey D. Erlikh ◽  
◽  
Alexey D. Erlikh ◽  
Dar'ia V. Riabova ◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Sglt2 Inhibitor ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Sglt2 Inhibitors ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure ◽  
Patients With Diabetes

This review presents the main results of recently (in 2020) published clinical studies investigating additional properties of drugs of the family of sodium-glucose co-transporter type 2 (SGLT2) inhibitors in patients with heart failure (HF). Of these, the most important is the EMPEROR-Reduced study which demonstrates the superiority of empagliflozin over placebo in preventing cardiovascular death and hospitalization for HF in patients with chronic HE with reduced left ventricular ejection fraction (LVEF). An important finding of this study is that, as in a recent study with a similar design with dapagliflozin – DAPA-HF, the benefit of SGLT2 inhibitors was independent on the presence or absence of diabetes mellitus in patients. The use of empagliflozin in patients with acute HF was studied in the EMPA-RESPONSE-AHF pilot study, in which, although there was no difference between placebo and the drug in the effect on the primary endpoint events, there was a clear trend towards improvement in clinical outcomes under the treatment with empagliflozin after 1 and 2 months of follow up. Administration of another member of the SGLT2 inhibitors family – sotagliflozin – in the SOLOIST-WHF study in patients with diabetes and recent worsening HF (with any LVEF) was associated with a significant decrease in adverse events. In the VERIT CV study, another SGLT2 inhibitor, ertugliflozin, although it had no effect on long-term outcomes in patients with diabetes and cardiovascular disease, was better than placebo in preventing hospitalization for heart failure. Overall, the recently completed studies of SGLT2 inhibitors show that drugs of this family, which already play an important role in the treatment of patients with HF with reduced LVEF, may in the future become an important component of therapy in a wider range of patients with various types of HF. Keywords: heart failure, sodium-glucose co-transporter type 2 inhibitors, empagliflozin, dapagliflozin, sotagliflozin, cardiovascular death For citation: Erlikh AD, Riabova DV. Sodium-glucose co-transporter-2 inhibitors in patients with heart failure. What's new? What are the prospects? Consilium Medicum. 2021; 23 (1): 48–51. DOI: 10.26442/20751753.2021.1.200681

Sign in / Sign up

Export Citation Format

Share Document