SGLT2 Inhibitors and Cardiovascular Outcomes: Do They Differ or There is a Class Effect? New Insights from the EMPA-REG OUTCOME trial and the CVD-REAL Study

Kyriakos, Georgios; Quiles-Sánchez, Lourdes Victoria; Garmpi, Anna; Farmaki, Paraskevi; Kyre, Konstantina; Savvanis, Spyridon; Antoniou, Vasileios; Memi, Eleni

doi:10.2174/1573403x15666190730094215

Cited by 10 publications

(9 citation statements)

References 30 publications

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“…Recent literature has reported the impact of Sodium-Glucose Co-transport 2 (SGLT-2) inhibitors in reducing ASCVD-related morbidity and mortality, especially among patients suffering with Diabetes Mellitus. 20,21 Furthermore, various studies have also advocated the use of Glucagon-like peptide 1 (GLP-1) receptor agonists cardiovascular and all-cause mortality. 17,[22][23][24] Nonetheless, none of our patients were on the aforementioned medications.…”

Section: Discussionmentioning

confidence: 99%

Magnitude, Distribution and Contextual Risk Enhancing Predictors of High 10-Year Cardiovascular Risk Among Diabetic Patients in Tanzania

Kassam¹,

Surani²,

Hameed³

et al. 2023

PROM

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Atherosclerotic Cardiovascular Disease (ASCVD) is the leading cause of death worldwide. In Diabetics, ASCVD is associated with poor prognosis and a higher case fatality rate compared with the general population. Sub-Saharan Africa is facing an epidemiological transition with ASCVD being prevalent among young adults. To date, over 20 million people have been living with DM in Africa, Tanzania being one of the five countries in the continent reported to have a higher prevalence. This study aimed to identify an individual's 10-year ASCVD absolute risk among a diabetic cohort in Tanzania and define contextual risk enhancing factors. Methods: A prospective observational study was conducted at the Aga Khan hospital, Mwanza, for a period of 8 months. The hospital is a 42-bed district-level hospital in Tanzania. Individuals 10-year risk was calculated based on the ASCVD 2013 risk calculator by ACC/AHA. Pearson's chi-square or Fischer's exact test was used to compare categorical and continuous variables. Multivariable analysis was applied to determine contextual factors for those who had a high 10-year risk of developing ASCVD. Results:The overall cohort included 573 patients. Majority of the individuals were found to be hypertensive (n = 371, 64.7%) and obese (n = 331, 58%) having a high 10-year absolute risk (n = 343, 60%) of suffering ASCVD. The study identified duration of Diabetes Mellitus (>10 years) (OR 8.15, 95% CI 5.25-14.42), concomitant hypertension (OR 1.82 95% CI 1.06-3.06), Diabetic Dyslipidemia (OR 1.44, 95% CI 1.08-1.92) and deranged serum creatinine (OR 1.03, 95% CI 1.02-1.03) to be the risk enhancing factors amongst our population. Conclusion:The study confirms the majority of diabetic individuals in the lake region of Tanzania to have a high 10-year ASCVD risk. The high prevalence of obesity, hypertension and dyslipidemia augments ASCVD risk but provides interventional targets for health-care workers to decrease these alarming projections.

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Section: Discussionmentioning

confidence: 99%

Magnitude, Distribution and Contextual Risk Enhancing Predictors of High 10-Year Cardiovascular Risk Among Diabetic Patients in Tanzania

Kassam¹,

Surani²,

Hameed³

et al. 2023

PROM

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“…Epidemiological studies indicate that improvements in T2DM management have led to significant reductions in diabetes-associated cardiovascular morbidity [36]. More recently, a new class of antidiabetic pharmaceuticals known as sodium glucose co-transporter (SGLT2) inhibitors have exhibited promise in ameliorating T2DM symptoms as well as reducing cardiovascular complications [37]. These preliminary improvements can potentially be further propelled if epigenetics is also considered.…”

Section: Type 2 Diabetes Mellitus (T2dm)mentioning

confidence: 99%

Traditional Therapeutics and Potential Epidrugs for CVD: Why Not Both?

Gladwell,

Ahiarah,

Rasheed

et al. 2023

Life

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Cardiovascular disease (CVD) is the leading cause of death worldwide. In addition to the high mortality rate, people suffering from CVD often endure difficulties with physical activities and productivity that significantly affect their quality of life. The high prevalence of debilitating risk factors such as obesity, type 2 diabetes mellitus, smoking, hypertension, and hyperlipidemia only predicts a bleak future. Current traditional CVD interventions offer temporary respite; however, they compound the severe economic strain of health-related expenditures. Furthermore, these therapeutics can be prescribed indefinitely. Recent advances in the field of epigenetics have generated new treatment options by confronting CVD at an epigenetic level. This involves modulating gene expression by altering the organization of our genome rather than altering the DNA sequence itself. Epigenetic changes are heritable, reversible, and influenced by environmental factors such as medications. As CVD is physiologically and pathologically diverse in nature, epigenetic interventions can offer a ray of hope to replace or be combined with traditional therapeutics to provide the prospect of addressing more than just the symptoms of CVD. This review discusses various risk factors contributing to CVD, perspectives of current traditional medications in practice, and a focus on potential epigenetic therapeutics to be used as alternatives.

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“…To reduce the risks of cardiovascular diseases, current clinical guidelines highlight the importance of a multifactorial approach in diabetic management, including the use of anti-diabetic agents [2,3]. The current literature suggests that novel anti-diabetic medications such as sodium-glucose cotransporter-2 inhibitors (SGLT2I) and glucagon-like peptide receptor agonists (GLP1a) demonstrate promising protective effects against various major adverse cardiovascular events (MACE) and mortality [4][5][6]. Some studies suggested that the cardiovascular benefit of SGLT2I and GLP1a is enhanced when used in conjunction [7].…”

Section: Introductionmentioning

confidence: 99%

Compare SGLT2I versus non-SGLT2I users in type-2 diabetic mellitus patients on GLP-1 receptor agonist: A population-based and machine learning causal inference analysis

Luo,

Chou,

et al. 2023

Preprint

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BackgroundBoth sodium-glucose cotransporter-2 (SGLT2) inhibitors and GLP-1 receptor agonists (GLP1a) demonstrated benefits against cardiovascular diseases in type 2 diabetes (T2D). However, the effects of SGLT2I amongst patients already on GLP1a users remain unknown.ObjectiveThis real-world study compared the risks of cardiovascular diseases with and without exposure to SGLT2I amongst GLP1a users.MethodsThis was a retrospective population-based cohort study of patients with type-2 diabetes mellitus (T2DM) on GLP1a between 1st January 2015 and 31st December 2020 using a territory-wide registry from Hong Kong. The primary outcomes were new-onset myocardial infarction, atrial fibrillation, heart failure, and stroke/transient ischaemic attack (TIA). The secondary outcome was all-cause mortality. Propensity score matching (1:2 ratio) using the nearest neighbour search was performed. Multivariable Cox regression was used to identify significant associations. The machine learning causal inference analysis was used to estimate the treatment effect.ResultsThis cohort included 2526 T2DM patients on GLP1a (median age: 52.5 years old [SD: 10.9]; 57.34 % males). The SGLT2I users and non-SGLT2I users consisted of 1968 patients and 558 patients, respectively. After matching, non-SGLT2I users were associated with high risks of myocardial infarction (Hazard ratio [HR]: 2.91; 95% Confidence Interval [CI]: 1.30-6.59) and heart failure (HR: 2.49; 95% CI: 1.22-5.08) compared to non-SGLT2I users after adjusting for demographics, comorbidities, medications, renal function, and glycaemic tests. However, non-SGLT2I users were not associated with the risks of atrial fibrillation (HR: 1.52; 95% CI: 0.65-3.53) and stroke/TIA (HR: 1.72; 95% CI: 0.70-4.24). The results remained consistent in the competing risk and the sensitivity analyses.ConclusionsSGLT2I non-users was associated with higher risks of myocardial infarction and heart failure when compared to SGLT2I users after adjustments amongst T2DM patients on GLP1a. The result remained consistent in the machine learning causal inference analysis.Graphical abstract

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SGLT2 Inhibitors and Cardiovascular Outcomes: Do They Differ or There is a Class Effect? New Insights from the EMPA-REG OUTCOME trial and the CVD-REAL Study

Cited by 10 publications

References 30 publications

Magnitude, Distribution and Contextual Risk Enhancing Predictors of High 10-Year Cardiovascular Risk Among Diabetic Patients in Tanzania

Magnitude, Distribution and Contextual Risk Enhancing Predictors of High 10-Year Cardiovascular Risk Among Diabetic Patients in Tanzania

Traditional Therapeutics and Potential Epidrugs for CVD: Why Not Both?

Compare SGLT2I versus non-SGLT2I users in type-2 diabetic mellitus patients on GLP-1 receptor agonist: A population-based and machine learning causal inference analysis

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