Effects of dapagliflozin in the progression of atherosclerosis in patients with type 2 diabetes: a meta-analysis of randomized controlled trials

Abstract

Aims At present, an increasing number of studies are trying to determine whether dapagliflozin has a significant effect on the occurrence and development of atherosclerosis in patients with type 2 diabetes mellitus (T2DM), but there is no consensus. In addition, the former meta-analyses, relying on only a few previous studies and a minimal number of research indicators, have not been able to draw sufficient conclusions simultaneously. Consequently, we conducted a meta-analysis to evaluate the effectiveness of dapagliflozin in the occurrence and development of atherosclerosis in patients with T2DM. Methods We searched electronic databases (PubMed, Embase, Cochrane, and Scopus) and reference lists in relevant papers for articles published in 2011–2021. We selected studies that evaluated the effects of dapagliflozin on the risk factors related to the occurrence or development of atherosclerosis in patients with T2DM. A fixed or random-effect model calculated the weighted average difference of dapagliflozin on efficacy, and the factors affecting heterogeneity were determined by Meta-regression analysis. Results Twelve randomized controlled trials (18,758 patients) were incorporated in our meta-analysis. In contrast with placebo, dapagliflozin was associated with a significantly increase in high density lipoprotein-cholesterol (HDL-C) [MD = 1.39; 95% CI (0.77, 2.01); P < 0.0001], Δflow-mediated vasodilatation (ΔFMD) [MD = 1.22; 95% CI (0.38, 2.06); P = 0.005] and estimated Glomerular Filtration Rate(eGFR) [MD = 1.94; 95% CI (1.38, 2.51); P < 0.00001]. Furthermore, dapagliflozin had a tremendous advantage in controlling triglycerides (TG) in subgroups whose baseline eGFR < 83 ml/min/1.73m2 [MD = − 10.38; 95% CI (− 13.15, − 7.60); P < 0.00001], systolic blood pressure (SBP) [MD = − 2.82; 95% CI (− 3.22, − 2.42); P < 0.00001], HbA1c, BMI, body weight and waist circumference. However, dapagliflozin has an adverse effect on increasing total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL-C). Besides, there were no significant changes in other indicators, including adiponectin and C-peptide immunoreactivity. Conclusions Our pooled analysis suggested that dapagliflozin has a terrifically better influence over HDL-C, ΔFMD, and eGFR, and it concurrently had a tremendous advantage in controlling TG, SBP, DBP, HbA1c, BMI, body weight, and waist circumference, but it also harms increasing TC and LDL-C. Furthermore, this study found that the effect of dapagliflozin that decreases plasma levels of TG is only apparent in subgroups of baseline eGFR < 83 ml/min/1.73m2, while the subgroup of baseline eGFR ≥ 83 ml/min/1.73m2 does not. Finally, the above results summarize that dapagliflozin could be a therapeutic option for the progression of atherosclerosis in patients with T2DM. Systematic review registration PROSPERO CRD42021278939.

Three months of combination therapy with nano‐curcumin reduces the inflammation and lipoprotein (a) in type 2 diabetic patients with mild to moderate coronary artery disease: Evidence of a randomized, double‐blinded, placebo‐controlled clinical trial

“…On the other hand, type 2 diabetes mellitus is a significant risk factor for cardiovascular diseases, such as myocardial infarction, heart failure, and atherosclerosis. 17 In addition, hyperglycemia, insulin resistance, advanced glycation end-products, and fatty acid accumulation in diabetes lead to increased oxidative stress, vascular and systemic inflammation, vasoconstriction, thrombosis, and atherogenesis. 18 Interestingly, cardiovascular death events are twice in type 2 diabetes mellitus patients than in non-diabetic patients.…”

“…Cardiovascular disorders are considered the leading cause of morbidity and mortality among patients with diabetes. On the other hand, type 2 diabetes mellitus is a significant risk factor for cardiovascular diseases, such as myocardial infarction, heart failure, and atherosclerosis 17 . In addition, hyperglycemia, insulin resistance, advanced glycation end‐products, and fatty acid accumulation in diabetes lead to increased oxidative stress, vascular and systemic inflammation, vasoconstriction, thrombosis, and atherogenesis 18 .…”

Effect of omentopexy/gastropexy on gastrointestinal symptoms after laparoscopic sleeve gastrectomy: A meta‐analysis of randomized controlled trials and systematic review

“…The study calculated the mean difference (MD) and odds ratios (OR) for 95% CIs, obtained the mean and SD from the continuous results and used a random‐effects model to measure these results. In order to understand the impact on the results, sensitivity analysis was performed to evaluate the impact on the results by excluding literature 14 . If an article is a source of heterogeneity, the study carefully evaluated its quality and bias and decided whether to continue to include it.…”

“…In order to understand the impact on the results, sensitivity analysis was performed to evaluate the impact on the results by excluding literature. 14 If an article is a source of heterogeneity, the study carefully evaluated its quality and bias and decided whether to continue to include it. A visual funnel plot and Egger's test evaluated the probability of publication bias, and the two-tailed P value <.05 was statistically significant.…”