Empagliflozin confers reno‐protection in acute myocardial infarction and type 2 diabetes mellitus

Mozawa, Kosuke; Kubota, Yoshiaki; Yu, Haitao; Tara, Shuhei; Tokita, Yukichi; Yodogawa, Kenji; Iwasaki, Yu‐ki; Yamamoto, Takeshi; Takano, Hitoshi; Tsukada, Yayoi; Asai, Kuniya; Miyamoto, Masaaki; Miyauchi, Yoshimasa; Kodani, Eitaro; Maruyama, Mitsunori; Tanabe, Jun; Shimizu, Wataru

doi:10.1002/ehf2.13509

Cited by 12 publications

(11 citation statements)

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“…After removing duplicate studies, the remaining 5,913 articles were screened. After reading 325 eligible full-text articles, 317 were excluded, and 8 studies met our inclusion criteria (8,13,(19)(20)(21)(22)(23)(24). After completing the manuscript, we searched the newly published literatures in PubMed, Embase and Cochrane Library.…”

Section: Search Resultsmentioning

confidence: 99%

Sodium Glucose Cotransporter Type 2 Inhibitors Improve Cardiorenal Outcome of Patients With Coronary Artery Disease: A Meta-Analysis

et al. 2022

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ObjectiveSodium glucose cotransporter type 2 inhibitors (SGLT-2i) are beneficial for cardiorenal outcomes in patients with type 2 diabetes mellitus (T2DM), heart failure (HF) or chronic kidney disease (CKD). However, whether or not the patients with coronary artery disease (CAD) have prognostic benefit from SGLT-2i treatment has not been fully studied. The purpose of this meta−analysis is to determine the prognostic benefit of SGLT-2i administration in CAD patients.MethodsWe searched the PubMed, Embase and Cochrane Library from inception until October 15, 2021. We included randomized controlled trials (RCTs) reporting the effect of SGLT-2i on major adverse cardiovascular event (MACE), hospitalization for heart failure (HHF), cardiovascular (CV) death and cardiorenal parameters in CAD patients. Hazard ratio (HR) with 95% confidence interval (CI) and mean difference (MD) from trials were meta-analyzed using fixed-effects models.ResultsNine trials enrolling 15,301 patients with CAD were included in the analyses. Overall, SGLT2i were associated with a reduced risk of MACE (HR: 0.84; 95% CI 0.74–0.95; I2 = 0%), HHF (HR: 0.69; 95% CI 0.58–0.83; I2 = 0%) and a composite of CV death or HHF (HR: 0.78; 95% CI 0.71–0.86; I2 = 37%) in CAD patients. Compared with control group, estimated glomerular filtration rate (eGFR) level decreased less in SGLT-2i group (mean difference [MD] = −3.60, 95% CI, −5.90 to −1.30, p = 0.002; I2 = 0%).ConclusionsSGLT-2i can improve cardiorenal outcomes in CAD patients. Further RCTs and real world studies are need to investigate the effect of SGLT2i on CAD patients.Systematic Review RegistrationPROSPERO, CRD42021258237.

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Section: Search Resultsmentioning

confidence: 99%

Sodium Glucose Cotransporter Type 2 Inhibitors Improve Cardiorenal Outcome of Patients With Coronary Artery Disease: A Meta-Analysis

et al. 2022

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“…Due to reduced glomerular filtration, CKD patients have attenuated glucosuria and weight loss (eGFR < 60 mL/min/1.73 m 2 ) [ 87 ]. A potential mechanism for the renoprotective effect of SGLT2 inhibitors may also involve uric acid reduction [ 88 , 89 ]. In T2DM patients with stage 2 or 3 CKD, SGLT2 inhibitors improved HbA1c and urinary albumin/creatinine ratios without increasing serious adverse renal events [ 90 , 91 ].…”

Section: Essential Effects Of Sglt2 Inhibitorsmentioning

confidence: 99%

“…Empagliflozin demonstrated renal protection in T2DM patients, as demonstrated in EMPA-REG OUTCOME, where empagliflozin was related to slower renal disease progression and a lower incidence of clinically relevant renal events compared with placebo (Table 4 ) [ 86 ]. Additionally, compared with placebo, empagliflozin improved uric acid levels with a lower risk of serious renal outcomes [ 68 , 86 , 88 ]. A sub-analysis of EMBODY trial reported that empagliflozin prevented the decline of renal function in T2DM patients with acute myocardial infarction, especially those with a baseline eGFR ≥ 60 mL/min/1.73 m 2 [ 88 ].…”

Section: Essential Effects Of Sglt2 Inhibitorsmentioning

confidence: 99%

“…Additionally, compared with placebo, empagliflozin improved uric acid levels with a lower risk of serious renal outcomes [ 68 , 86 , 88 ]. A sub-analysis of EMBODY trial reported that empagliflozin prevented the decline of renal function in T2DM patients with acute myocardial infarction, especially those with a baseline eGFR ≥ 60 mL/min/1.73 m 2 [ 88 ]. Uric acid reduced about 0.9 mg/dL in the empagliflozin group (P < 0.001) [ 88 ].…”

Section: Essential Effects Of Sglt2 Inhibitorsmentioning

confidence: 99%

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The current role of sodium-glucose cotransporter 2 inhibitors in type 2 diabetes mellitus management

Kang

et al. 2022

Cardiovasc Diabetol

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Type 2 diabetes mellitus (T2DM) is a chronic, complex metabolic disease characterized by chronic hyperglycemia causing from insufficient insulin signaling because of insulin resistance or defective insulin secretion, and may induce severe complications and premature death. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are oral drugs used to reduce hyperglycemia in patients with T2DM, including empagliflozin, ertugliflozin, dapagliflozin and canagliflozin. The primary objective of this article is to examine the clinical benefit, safety, and tolerability of the four SGLT2 inhibitors approved by the US FDA. SGLT2 inhibitors increase urinary glucose excretion via inhibiting SGLT2 to decrease renal reabsorption of filtered glucose and reduce the renal threshold for glucose. Rather than stimulating insulin release, SGLT2 inhibitors improve β-cell function by improving glucotoxicity, as well as reduce insulin resistance and increase insulin sensitivity. Early clinical trials have confirmed the beneficial effects of SGLT2 in T2DM with acceptable safety and excellent tolerability. In recent years, SGLT2 inhibitors has been successively approved by the FDA to decrease cardiovascular death and decrease the risk of stroke and cardiac attack in T2DM adults who have been diagnosed with cardiovascular disease, treating heart failure (HF) with reduced ejection fraction and HF with preserved ejection fraction, and treat diabetic kidney disease (DKD), decrease the risk of hospitalization for HF in T2DM and DKD patients. SGLT2 inhibitors are expected to be an effective treatment for T2DM patients with non alcoholic fatty liver disease. SGLT2 inhibitors have a similar safety profile to placebo or other active control groups, with major adverse events such as Ketoacidosis or hypotension and genital or urinary tract infections.

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“…Empaglifl ozin prevented kidney function decline in patients with AMI and T2DM, especially those with baseline eGFR ≥ 60 mL/min/1.73 m2. Early administration of sodiumglucose cotransporter 2 inhibitors in these patients is considered desirable for renal protection [21]. b) Sigh is a cyclic brief recruitment maneuver: previous physiologic studies showed that its use could be an interesting addition to pressure support ventilation to improve lung elastance, decrease regional heterogeneity, and increase the release of surfactant.…”

Section: Relative To Therapies In Patients With Cardiorenal Syndromementioning

confidence: 99%

Heart Failure (HF): Recent innovations in clinical therapy and critical profiles of acute and chronic forms

Perrotta¹

2022

J Cardiovasc Med Cardiol

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Background and objectives: Heart failure is a pathological condition characterized by the inability of the heart to pump (cardiac output) an adequate amount of blood to meet the metabolic needs of the body or, at any rate, to be able to do so only at the expense of increased filling pressures in one or more cardiac chambers and the upstream venous circulation. The research group states here the primary objective of expanding the indications contained in the ESC 2021 with the results of the last year on the subject of treatment profiles, to facilitate a better understanding of the overall clinical picture and contribute to the next edition of the guidelines. Materials and methods: Systematic literature review in the English language from January 1, 2021, to September 30, 2022, on PubMed/MedLine, Web on Science, and Cochrane archive. Our search strategy retrieved 8,317 articles. We excluded books and papers, meta-analyses, reviews, and systematic reviews and selected only 46 studies most significant about the clinical trial and randomized controlled trial. Results: The recent ESC 2021 guidelines are accurate and timely, and have confirmed their usefulness from a functional perspective, including concerning certain aspects that were represented as a “grey area”. Early risk prediction plays a key role in the subsequent management of patients, and to optimize risk prediction and intensity of management, one should take into account that: a) biomarkers have improved the understanding of the pathophysiology of heart failure and may therefore help to adjust the intensity of management in AHF; b) among the wide variety of biomarkers currently available, NT-proBNP and cTn seem the most promising in this indication; c) among the risk scores described, those combining demographic and clinical parameters with biomarkers in a model with routinely available rapid variables seem the most promising tools; d) in addition to biomarkers, age, systolic blood pressure, respiratory rate, oxygen saturation, creatinine, electrolytes, and blood urea nitrogen are the most commonly used predictor variables in the risk scores described; e) among the models selected, the MEESSI-AHF risk score appears to be currently the most promising tool for predicting the risk of AHF; f) during the management of decompensated patients (and in later stages), the psychological aspect is completely ignored, thus promoting the worsening of psychological symptoms (the need is as evident during the acute episode as it is in the daily management of chronic heart failure). Conclusions: The scientific literature search enriched the structure of ESC 2021, suggesting its implementation, with other findings related to new drug therapies such as Sotagliflozin, Hydrochlorothiazide Apabetalone, Alprostadil, Empagliflozin, Sacubitril/Valsartan, Dapagliflozin, Sodium-glucose co-transporter-2 inhibitors, and biomarkers such as Urinary sodium (UNa+), IL-6 levels and rh-brain natriuretic peptide (rhBNP), as well as the use of mindful breathing session, osteopathic manipulative treatment, electrical muscle stimulation, low-level tragus stimulation, venoarterial extracorporeal membrane oxygenation, oral nutritional supplements, and the correlative hypothesis between heart failure and intestinal dysbiosis, also concerning the psychological profile. However, these clinical studies suffer from some limitations that will necessarily have to be taken into account, such as the limited size of the population sample selected or the conflict of interest determined by the fact that some research is funded by the same pharmaceutical company producing the drug used that do not necessarily represent a negative limitation on the results obtained from studies.

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Empagliflozin confers reno‐protection in acute myocardial infarction and type 2 diabetes mellitus

Cited by 12 publications

References 30 publications

Sodium Glucose Cotransporter Type 2 Inhibitors Improve Cardiorenal Outcome of Patients With Coronary Artery Disease: A Meta-Analysis

Sodium Glucose Cotransporter Type 2 Inhibitors Improve Cardiorenal Outcome of Patients With Coronary Artery Disease: A Meta-Analysis

The current role of sodium-glucose cotransporter 2 inhibitors in type 2 diabetes mellitus management

Heart Failure (HF): Recent innovations in clinical therapy and critical profiles of acute and chronic forms

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