Impact of chronic GLP-1 RA and SGLT-2I therapy on in-hospital outcome of diabetic patients with acute myocardial infarction

Abstract

Background Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium glucose cotransporter-2 inhibitors (SGLT-2i) demonstrated cardiovascular and renal protection. Whether their benefits occur also during hospitalization for acute myocardial infarction (AMI) in patients with diabetes mellitus (DM) is not known. We evaluated in-hospital outcomes of patients hospitalized with AMI according to their chronic use of GLP-1 RA and/or SGLT-2i. Methods Using the health administrative databases of Lombardy, patients hospitalized with AMI from 2010 to 2019 were included. They were stratified according to DM status, then grouped into three cohorts using a propensity score matching: non-DM patients; DM patients treated with GLP-1 RA and/or SGLT-2i; DM patients not treated with GLP-1 RA/SGLT-2i. The primary endpoint of the study was the composite of in-hospital mortality, acute heart failure, and acute kidney injury requiring renal replacement therapy. Results We identified 146,798 patients hospitalized with AMI (mean age 71 ± 13 years, 34% females, 47% STEMI; 26% with DM). After matching, 3,090 AMI patients (1030 in each group) were included in the analysis. Overall, the primary endpoint rate was 16% (n = 502) and progressively increased from non-DM patients to DM patients treated with and without GLP-1 RA/SGLT-2i (13%, 16%, and 20%, respectively; P < 0.0001). Compared with non-DM patients, DM patients with GLP-1 RA/SGLT-2i had a 30% higher risk of the primary endpoint, while those not treated with GLP-1 RA/SGLT-2i had a 60% higher risk (P < 0.0001). Conclusion Chronic therapy with GLP-1 RA and/or SGLT-2i has a favorable impact on the clinical outcome of DM patients hospitalized with AMI.

SGLT2 inhibitor improves the prognosis of patients with coronary heart disease and prevents in-stent restenosis

“…This suggests the notion that dapagliflozin partially corrects cardiac dysfunction through glucose-lowering effects. Long-term application of SGLT2 inhibitors has a good effect on the clinical prognosis of hospitalized patients with AMI after PCI, and it can narrow the prognostic gap still existing between DM and non-DM patients ( 65 ).…”

Unraveling the Cardiac Matrix: From Diabetes to Heart Failure, Exploring Pathways and Potential Medications

“…Initiating GLP-1RAs therapy shortly after a first AMI in patients with diabetes has been linked to a reduced risk of significant CV events [ 189 ]. Long-term treatment with GLP-1RAs and/or SGLT-2i positively impacts the clinical prognosis of patients with diabetes that are hospitalized with AMI [ 190 , 191 ].…”

Comité de Gerontología. Abordaje clínico terapéutico del adulto mayor con diabetes mellitus

“…En casos especiales, como comorbilidad cardiovascular severa o renal incipiente, vale pensar en SLGT-2 o análogos de GLP-1 que también son beneficiosos en caso de deterioro cognitivo y obesidad mórbida. Sin embargo, hay que considerar los efectos colaterales, costo, repercusión hemodinámica, pancreatitis, caídas, fracturas, internaciones, casos de depresión y mortalidad, especialmente en mayores de 75 años 8,[27][28][29][30][31][32] .…”

“…Revista de la Sociedad Argentina de Diabetes 2024; Vol. 58 (28)(29)(30)(31)(32) The development of civilization is associated with an increase in the age of the population. Today in Argentina, the elderly man (AM: person aged 65 years or older) has a life expectancy of 76 years and women 80 years, which represents 15% of the percentage of the population in large urban centers.…”

“…Revista de la Sociedad Argentina de Diabetes Año 58 Vol. 58 Nº 1 Suplemento Recomendaciones de los Comités de Trabajo Enero-abril de 2024:[28][29][30][31][32] ISSN 0325-5247 (impresa) ISSN 2346-9420 (en línea) Comité de Gerontología. Abordaje clínico terapéutico del adulto mayor con diabetes mellitus/ Recomendaciones…”