The Clinical Effect of Dapagliflozin in Patients with Angiographically Confirmed Coronary Artery Disease and Concomitant Type 2 Diabetes Mellitus

Keywords: glycemic variability, coronary artery disease, optimal drug treatment, percutaneous coronary intervention, sodium-glucose cotransporter-2 inhibitors

Abstract

Nowadays treatment of patients with coronary artery disease (CAD) and concomitant type 2 diabetes mellitus (DM) needs further study.

The aim. Evaluation of the clinical effect and glycemic variability of dapagliflozin in patients with angiographically confirmed CAD and concomitant type 2 DM.

Materials and methods. The study involved 47 patients with angiographically confirmed CAD. The patients underwent laboratory blood tests, electrocardiography, echocardiography, continuous glucose monitoring and percutaneous coronary intervention (PCI). Depending on the usage of dapagliflozin 10 mg, the patients were divided into 2 groups: group I (+SGLT2i, n = 24) and group II (–SGLT2i, n = 23). The average follow-up period was 16 months.

Results. Distribution of the examined patients by age, anthropometric characteristics, duration of DM, functional state of the heart and kidneys, smoking, the presence of acute cardiovascular events and previous PCI showed no statistically significant difference. In patients of group I, on the background of taking SGLT2i, a decrease in body mass index and improved glycemic profile were revealed. Patients in group II were more likely to have complaints of angina (4 [17.3%] vs 1 [4.3%], p>0.05); repeated coronary angiography in this group was significantly more likely to reveal progression to atherosclerotic CAD (4 [17.3%], p<0.05) which required re-revascularization. No fatalities were detected during the follow-up.

Conclusion. Dapagliflozin has improved glycemic and lipid profile of the blood and long-term prognosis after PCI. Adding this drug to the treatment reduces the clinical progression of CAD, the need for re-hospitalization and cardiac revascularization.

References

  1. Khan MA, Hashim MJ, Mustafa H, Baniyas MY, Al Suwaidi SKBM, AlKatheeri R, et al. Global Epidemiology of Ischemic Heart Disease: Results from the Global Burden of Disease Study. Cureus. 2020;12(7):e9349. https://doi.org/10.7759/cureus.9349
  2. Rao Kondapally Seshasai S, Kaptoge S, Thompson A, Di Angelantonio E, Gao P, Sarwar N, et al.; Emerging Risk Factors Collaboration. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med. 2011;364(9):829-41. https://doi.org/10.1056/NEJMoa1008862. Erratum in: N Engl J Med. 2011;364(13):1281.
  3. Lima EG, Hueb W, Garcia RM, Pereira AC, Soares PR, Favarato D, et al. Impact of diabetes on 10-year outcomes of patients with multivessel coronary artery disease in the Medicine, Angioplasty, or Surgery Study II (MASS II) trial. Am Heart J. 2013;166(2):250-7. https://doi.org/10.1016/j.ahj.2013.04.017
  4. Barnett AH, Mithal A, Manassie J, Jones R, Rattunde H, Woerle HJ, et al.; EMPA-REG RENAL trial investigators. Efficacy and safety of empagliflozin added to existing antidiabetes treatment in patients with type 2 diabetes and chronic kidney disease: a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol. 2014;2(5):369-84. https://doi.org/10.1016/S2213-8587(13)70208-0
  5. Shah SR, Najim NI, Abbasi Z, Fatima M, Jangda AA, Shahnawaz W, et al. Canagliflozin and Cardiovascular disease- results of the CANVAS trial. J Community Hosp Intern Med Perspect. 2018;8(5):267-8. https://doi.org/10.1080/20009666.2018.1521245
  6. Wiviott SD, Raz I, Bonaca MP, Mosenzon O, Kato ET, Cahn A, et al.; DECLARE–TIMI 58 Investigators. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2019;380(4):347-57. https://doi.org/10.1056/NEJMoa1812389
  7. Battelino T, Danne T, Bergenstal RM, Amiel SA, Beck R, Biester T, et al. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range. Diabetes Care. 2019;42(8):1593-603. https://doi.org/10.2337/dci19-0028
  8. Reno CM, Daphna-Iken D, Chen YS, VanderWeele J, Jethi K, Fisher SJ. Severe hypoglycemia-induced lethal cardiac arrhythmias are mediated by sympathoadrenal activation. Diabetes. 2013;62(10):3570-81. https://doi.org/10.2337/db13-0216
  9. Ratter JM, Rooijackers HM, Tack CJ, Hijmans AG, Netea MG, de Galan BE, et al. Proinflammatory Effects of Hypoglycemia in Humans With or Without Diabetes. Diabetes. 2017;66(4):1052-61. https://doi.org/10.2337/db16-1091
  10. Cwikiel J, Seljeflot I, Berge E, Njerve IU, Ulsaker H, Arnesen H, Flaa A. Effect of strenuous exercise on mediators of inflammation in patients with coronary artery disease. Cytokine. 2018;105:17-22. https://doi.org/10.1016/j.cyto.2018.02.006
  11. Gogitidze Joy N, Hedrington MS, Briscoe VJ, Tate DB, Ertl AC, Davis SN. Effects of acute hypoglycemia on inflammatory and pro-atherothrombotic biomarkers in individuals with type 1 diabetes and healthy individuals. Diabetes Care. 2010;33(7):1529-35. https://doi.org/10.2337/dc09-0354. Erratum in: Diabetes Care. 2010;33(9):2129.
  12. Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington RP, Goff DC Jr, Bigger JT, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545-59. https://doi.org/10.1056/NEJMoa0802743
  13. Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al.; VADT Investigators. Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes. N Engl J Med. 2009;360(2):129-39. https://doi.org/10.1056/NEJMoa0808431. Erratum in: N Engl J Med. 2009;361(10):1028. Erratum in: N Engl J Med.2009;361(10):1024-5.
  14. Kaplinsky E. DAPA-HF trial: dapagliflozin evolves from a glucose-lowering agent to a therapy for heart failure. Drugs Context. 2020;9:2019-11-3. https://doi.org/10.7573/dic.2019-11-3
  15. Packer M, Anker SD, Butler J, Filippatos G, Ferreira JP, Pocock SJ, et al.; EMPEROR-Reduced Trial Committees and Investigators. Empagliflozin in Patients With Heart Failure, Reduced Ejection Fraction, and Volume Overload: EMPEROR-Reduced Trial. J Am Coll Cardiol. 2021;77(11):1381-92. https://doi.org/10.1016/j.jacc.2021.01.033
  16. Lee SH, Min KW, Lee BW, Jeong IK, Yoo SJ, Kwon HS, et al. Effect of Dapagliflozin as an Add-on Therapy to Insulin on the Glycemic Variability in Subjects with Type 2 Diabetes Mellitus (DIVE): A Multicenter, Placebo-Controlled, Double-Blind, Randomized Study. Diabetes Metab J. 2021;45(3):339-48. https://doi.org/10.4093/dmj.2019.0203
  17. International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32(7):1327-34. https://doi.org/10.2337/dc09-9033
Published
2022-09-26
How to Cite
Dzhun, Y. Y., Marushko, Y. Y., Saienko, Y. A., Rudenko, N. M., & Mankovsky, B. M. (2022). The Clinical Effect of Dapagliflozin in Patients with Angiographically Confirmed Coronary Artery Disease and Concomitant Type 2 Diabetes Mellitus. Ukrainian Journal of Cardiovascular Surgery, 30(3), 35-43. https://doi.org/10.30702/ujcvs/22.30(03)/DM031-3543

Most read articles by the same author(s)