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Ansari HUH, Qazi SU, Sajid F, Altaf Z, Ghazanfar S, Naveed N, Ashfaq AS, Siddiqui AH, Iqbal H, Qazi S. Efficacy and Safety of Glucagon-Like Peptide-1 Receptor Agonists on Body Weight and Cardiometabolic Parameters in Individuals With Obesity and Without Diabetes: A Systematic Review and Meta-Analysis. Endocr Pract 2024; 30:160-171. [PMID: 38029929 DOI: 10.1016/j.eprac.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/02/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), initially for type 2 diabetes mellitus, show promise in promoting weight loss and improving heart health in obese individuals without diabetes. Our goal was to examine existing research for conclusive evidence on various types of GLP-1 RAs for weight loss and cardiometabolic benefits in obesity without diabetes. METHODS We conducted an electronic search on PubMed, Scopus, and Cochrane Central using keywords, such as "GLP-1 RA," "obesity," and "weight loss." We considered all available global GLP-1 RAs for inclusion. Our analysis focused on weight loss, blood pressure (BP) changes (systolic and diastolic BPs), and lipid profile effects (high-density lipoprotein, low-density lipoprotein, total cholesterol, and triacylglycerol). We used a random-effects meta-analysis with the standardized mean difference (SMD), mean difference (MD), odds ratio, and relative risk to present the results. RESULTS Our search yielded a total of 7535 articles. We included 15 trials in our study. GLP-1 RAs led to significant weight loss (MD, -8.77 kg; P <.01) in obese individuals. GLP-1 RAs also improved the systolic BP (MD, -4.13 mm Hg; P <.01), diastolic BP (MD, -1.39 mm Hg; P <.01), and lipid profiles, including improved levels of triacylglycerol (SMD, -0.99 mg/dL; P <.01), total cholesterol (SMD, -0.73 mg/dL; P <.01), very low-density lipoprotein (SMD, -1.11 mg/dL; P <.01), and low-density lipoprotein (SMD, -0.27 mg/dL; P <.01), and significantly increased high-density lipoprotein levels (SMD, 0.11 mg/dL; P <.01). However, GLP-1 RAs were associated with an increased risk of gastrointestinal adverse events. CONCLUSION GLP-1 RAs were found to be beneficial for not only weight loss but also reduction in risk factors for cardiovascular disease such as BP and lipid profile. Consistent beneficial results were observed across the various subtypes of GLP-1 RAs.
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Affiliation(s)
| | - Shurjeel Uddin Qazi
- Department of Internal Medicine, Dow University of Health Sciences, Pakistan
| | - Faiza Sajid
- Department of Medicine, Liaquat National Hospital and Medical College, Pakistan
| | - Zahabia Altaf
- Department of Internal Medicine, Dow University of Health Sciences, Pakistan
| | - Shamas Ghazanfar
- Department of Internal Medicine, Dow University of Health Sciences, Pakistan
| | - Naveen Naveed
- Department of Medicine, Jinnah Sindh Medical University, Pakistan
| | - Amna Shakil Ashfaq
- Department of Internal Medicine, Dow University of Health Sciences, Pakistan
| | | | - Hamza Iqbal
- Department of Internal Medicine, Dow University of Health Sciences, Pakistan
| | - Sana Qazi
- Department of Internal Medicine, Dow University of Health Sciences, Pakistan
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Fysekidis M, Cosson E, Sabouret P, Takbou K, Sutton A, Charnaux N, Banu I, Testa A, Biondi-Zoccai G, Vicaut E, Valensi P. Insulin analogs as an add-on to metformin after failure to oral treatment in type 2 diabetic patients increase diastole duration. The INSUlin Regimens and VASCular Functions (INSUVASC) study. Minerva Cardiol Angiol 2023; 71:659-672. [PMID: 37405711 DOI: 10.23736/s2724-5683.23.06139-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND Fast acting insulin analogues are known to improve arterial stiffness. The combination of metformin with insulin represents a widely used therapeutic strategy in diabetes. We hypothesized that insulin treatment in patients with type 2 diabetes (T2D) with long-acting, fast-acting or basal bolus insulin as an add-on to metformin would provide additional improvement of arterial stiffness. METHODS The INSUlin Regimens and VASCular Functions (INSUVASC) study is a pilot, randomized, open label three-arms study that included 42 patients with type 2 diabetes (T2D) in primary prevention, after a failure to oral antidiabetic agents. Arterial stiffness measurements were performed at fasting and after a standardized breakfast. During the first visit (V1) pre-randomization, participants took only metformin to perform the tests. The same tests were repeated after 4 weeks of insulin treatment during the second visit (V2). RESULTS Data were available for final analysis in 40 patients, with a mean age of 53.6±9.7 years and a mean duration of diabetes of 10.6±5.6 years. Twenty-one were females (52.5%), hypertension and dyslipidemia were present in 18 (45%) and 17 patients (42.5%), respectively. After insulin treatment, the metabolic control was associated to a decrease in oxidative stress and improvement of endothelial functions, with a post prandial diastole duration increased and a decrease of the peripheral arterial stiffness, with a better post prandial pulse pressure ratio and ejection duration after insulin. In hypertensive patients, insulin treatment provided positive effects by decreasing the pulse wave velocity and improving reflection time. CONCLUSIONS A short time treatment by insulin in addition to metformin improved myocardial perfusion. Moreover, insulin treatment in hypertensive patients provides a better hemodynamic profile in large arteries.
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Affiliation(s)
- Marinos Fysekidis
- Department of Endocrinology, Jean Verdier Hospital, Assistence Publique - Hôpitaux de Paris, Paris13 University, Sorbonne Paris Cité, Paris, France -
- Department of Diabetology-Nutrition, Research Center for Human Nutrition of Ile-de-France, Integrated Obesity Center of North Ile-de-France (CINFO), Bondy, France -
- Center of Research in Epidemiology and Statistics (UMR U1153), National Institute of Health and Medical Research (Inserm), Université Paris13, Sorbonne Paris Cité, Bobigny, France -
| | - Emmanuel Cosson
- Department of Endocrinology, Jean Verdier Hospital, Assistence Publique - Hôpitaux de Paris, Paris13 University, Sorbonne Paris Cité, Paris, France
- Department of Diabetology-Nutrition, Research Center for Human Nutrition of Ile-de-France, Integrated Obesity Center of North Ile-de-France (CINFO), Bondy, France
- Center of Research in Epidemiology and Statistics (UMR U1153), National Institute of Health and Medical Research (Inserm), Université Paris13, Sorbonne Paris Cité, Bobigny, France
| | - Pierre Sabouret
- Heart Institute, Pitié-Salpétrière Hospital, Sorbonne University, Paris, France
- National College of French Cardiologists, Paris, France
| | - Karim Takbou
- Department of Endocrinology, Jean Verdier Hospital, Assistence Publique - Hôpitaux de Paris, Paris13 University, Sorbonne Paris Cité, Paris, France
| | - Angela Sutton
- Biochemistry Department, Jean Verdier Hospital, Assistence Publique - Hôpitaux de Paris, Bondy, France
| | - Nathalie Charnaux
- Biochemistry Department, Jean Verdier Hospital, Assistence Publique - Hôpitaux de Paris, Bondy, France
| | - Isabela Banu
- Department of Endocrinology, Jean Verdier Hospital, Assistence Publique - Hôpitaux de Paris, Paris13 University, Sorbonne Paris Cité, Paris, France
| | - Alberto Testa
- Sapienza School for Advanced Studies, Sapienza University, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Eric Vicaut
- Clinical Research Unit, Lariboisière-St Louis, Fernand Widal Hospitals, Assistence Publique - Hôpitaux de Paris, Paris, France
| | - Paul Valensi
- Department of Endocrinology, Jean Verdier Hospital, Assistence Publique - Hôpitaux de Paris, Paris13 University, Sorbonne Paris Cité, Paris, France
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Stampouloglou PK, Anastasiou A, Bletsa E, Lygkoni S, Chouzouri F, Xenou M, Katsarou O, Theofilis P, Zisimos K, Tousoulis D, Vavuranakis M, Siasos G, Oikonomou E. Diabetes Mellitus in Acute Coronary Syndrome. Life (Basel) 2023; 13:2226. [PMID: 38004366 PMCID: PMC10671950 DOI: 10.3390/life13112226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
The global prevalence of diabetes mellitus (DM) has led to a pandemic, with significant microvascular and macrovascular complications including coronary artery disease (CAD), which worsen clinical outcomes and cardiovascular prognosis. Patients with both acute coronary syndrome (ACS) and DM have worse prognosis and several pathophysiologic mechanisms have been implicated including, insulin resistance, hyperglycemia, endothelial dysfunction, platelet activation and aggregations as well as plaque characteristics and extent of coronary lesions. Therefore, regarding reperfusion strategies in the more complex anatomies coronary artery bypass surgery may be the preferred therapeutic strategy over percutaneous coronary intervention while both hyperglycemia and hypoglycemia should be avoided with closed monitoring of glycemic status during the acute phase of myocardial infraction. However, the best treatment strategy remains undefined. Non-insulin therapies, due to the low risk of hypoglycemia concurrently with the multifactorial CV protective effects, may be proved to be the best treatment option in the future. Nevertheless, evidence for the beneficial effects of glucagon like peptide-1 receptor agonists, dipeptidyl-peptidase 4 inhibitors and sodium glycose cotransporter 2 inhibitors, despite accumulating, is not robust and future randomized control trials may provide more definitive data.
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Affiliation(s)
- Panagiota K. Stampouloglou
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
| | - Artemis Anastasiou
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
| | - Evanthia Bletsa
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
| | - Stavroula Lygkoni
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
| | - Flora Chouzouri
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
| | - Maria Xenou
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
| | - Ourania Katsarou
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
| | - Panagiotis Theofilis
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.T.); (D.T.)
| | - Konstantinos Zisimos
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
| | - Dimitris Tousoulis
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.T.); (D.T.)
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
| | - Gerasimos Siasos
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
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Shi R, Yang ZG, Guo YK, Qian WL, Gao Y, Li XM, Jiang L, Xu HY, Li Y. The right ventricular dysfunction and ventricular interdependence in patients with DM: assessment using cardiac MR feature tracking. Cardiovasc Diabetol 2023; 22:93. [PMID: 37085847 PMCID: PMC10122304 DOI: 10.1186/s12933-023-01806-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/16/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND To investigate the difference of right ventricular (RV) structural and functional alteration in patients with diabetes mellitus (DM) with preserved left ventricular ejection fraction (LVEF), and the ventricular interdependence in these patients, using cardiac MR (CMR) feature tracking. METHODS From December 2016 to February 2022, 148 clinically diagnosed patients with DM who underwent cardiac MR (CMR) in our hospital were consecutively recruited. Fifty-four healthy individuals were included as normal controls. Biventricular strains, including left/right ventricular global longitudinal strain (LV-/RVGLS), left/right ventricular global circumferential strain (LV-/RVGCS), left/right ventricular global radial strain (LV-/RVGRS) were evaluated, and compared between patients with DM and healthy controls. Multiple linear regression and mediation analyses were used to evaluate DM's direct and indirect effects on RV strains. RESULTS No differences were found in age (56.98 ± 10.98 vs. 57.37 ± 8.41, p = 0.985), sex (53.4% vs. 48.1%, p = 0.715), and body surface area (BSA) (1.70 ± 0.21 vs. 1.69 ± 0.17, p = 0.472) between DM and normal controls. Patients with DM had decreased RVGLS (- 21.86 ± 4.14 vs. - 24.49 ± 4.47, p = 0.001), RVGCS (- 13.16 ± 3.86 vs. - 14.92 ± 3.08, p = 0.011), and no decrease was found in RVGRS (22.62 ± 8.11 vs. 23.15 ± 9.05, p = 0.743) in patients with DM compared with normal controls. The difference in RVGLS between normal controls and patients with DM was totally mediated by LVGLS (indirect effecting: 0.655, bootstrapped 95%CI 0.138-0.265). The difference in RVGCS between normal controls and DM was partly mediated by the LVGLS (indirect effecting: 0.336, bootstrapped 95%CI 0.002-0.820) and LVGCS (indirect effecting: 0.368, bootstrapped 95%CI 0.028-0.855). CONCLUSIONS In the patients with DM and preserved LVEF, the difference in RVGLS between DM and normal controls was totally mediated by LVGLS. Although there were partly mediating effects of LVGLS and LVGCS, the decrease in RVGCS might be directly affected by the DM.
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Affiliation(s)
- Rui Shi
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Wen-Lei Qian
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xue-Ming Li
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Hua-Yan Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Trombara F, Cosentino N, Bonomi A, Ludergnani M, Poggio P, Gionti L, Baviera M, Colacioppo P, Roncaglioni MC, Leoni O, Bortolan F, Agostoni P, Genovese S, Marenzi G. Impact of chronic GLP-1 RA and SGLT-2I therapy on in-hospital outcome of diabetic patients with acute myocardial infarction. Cardiovasc Diabetol 2023; 22:26. [PMID: 36747186 PMCID: PMC9903538 DOI: 10.1186/s12933-023-01758-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/27/2023] [Indexed: 02/08/2023] Open
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.
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Affiliation(s)
- Filippo Trombara
- grid.418230.c0000 0004 1760 1750Centro Cardiologico Monzino, I.R.C.C.S, Via Parea 4, 20138 Milan, Italy
| | - Nicola Cosentino
- grid.418230.c0000 0004 1760 1750Centro Cardiologico Monzino, I.R.C.C.S, Via Parea 4, 20138 Milan, Italy ,grid.4708.b0000 0004 1757 2822Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alice Bonomi
- grid.418230.c0000 0004 1760 1750Centro Cardiologico Monzino, I.R.C.C.S, Via Parea 4, 20138 Milan, Italy
| | - Monica Ludergnani
- grid.418230.c0000 0004 1760 1750Centro Cardiologico Monzino, I.R.C.C.S, Via Parea 4, 20138 Milan, Italy
| | - Paolo Poggio
- grid.418230.c0000 0004 1760 1750Centro Cardiologico Monzino, I.R.C.C.S, Via Parea 4, 20138 Milan, Italy
| | - Luigia Gionti
- grid.418230.c0000 0004 1760 1750Centro Cardiologico Monzino, I.R.C.C.S, Via Parea 4, 20138 Milan, Italy
| | - Marta Baviera
- grid.4527.40000000106678902Laboratory of Cardiovascular Prevention, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Pierluca Colacioppo
- grid.4527.40000000106678902Laboratory of Cardiovascular Prevention, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maria Carla Roncaglioni
- grid.4527.40000000106678902Laboratory of Cardiovascular Prevention, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Olivia Leoni
- Regional Epidemiological Observatory, Lombardy Region, Milan, Italy
| | | | - Piergiuseppe Agostoni
- grid.418230.c0000 0004 1760 1750Centro Cardiologico Monzino, I.R.C.C.S, Via Parea 4, 20138 Milan, Italy ,grid.4708.b0000 0004 1757 2822Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Stefano Genovese
- grid.418230.c0000 0004 1760 1750Centro Cardiologico Monzino, I.R.C.C.S, Via Parea 4, 20138 Milan, Italy
| | - Giancarlo Marenzi
- Centro Cardiologico Monzino, I.R.C.C.S, Via Parea 4, 20138, Milan, Italy.
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Pérez-Belmonte LM, Sanz-Cánovas J, García de Lucas MD, Ricci M, Avilés-Bueno B, Cobos-Palacios L, Pérez-Velasco MA, López-Sampalo A, Bernal-López MR, Jansen-Chaparro S, Miramontes-González JP, Gómez-Huelgas R. Efficacy and Safety of Semaglutide for the Management of Obese Patients With Type 2 Diabetes and Chronic Heart Failure in Real-World Clinical Practice. Front Endocrinol (Lausanne) 2022; 13:851035. [PMID: 35813629 PMCID: PMC9263111 DOI: 10.3389/fendo.2022.851035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/26/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The impact of glucagon-like peptide-1 receptor agonists on patients with heart failure has not been fully described. Our main objective was to evaluate the safety and clinical and glycemic efficacy of once-weekly semaglutide in obese patients with type 2 diabetes and heart failure. METHODS In this observational, retrospective, real-world study, we enrolled outpatients with type 2 diabetes, obesity, and heart failure who started semaglutide and were followed-up on at 3, 6, and 12 months. RESULTS A total of 136 patients were included. From baseline to 12 months, there was a significant improvement on the Kansas City Cardiomyopathy Questionnaire total symptom score (59.0 ± 24.1 vs 79.9 ± 28.4 points, p<0.01), a reduction in the proportion of patients with New York Heart Association functional class III (40.4% to 16.2%, p<0.01), and a reduction in N-terminal pro-brain natriuretic peptide levels (969.5 ± 653.5 vs 577.4 ± 322.1 pg/mL, p<0.01). Emergency department visits due to heart failure, hospitalizations due to heart failure, and all-cause hospitalizations also declined. Additionally, significant reductions in glycated hemoglobin (-1.4%) and body weight (-12.7 kilograms) were observed as well as a de-intensification of antidiabetic therapy. Moreover, semaglutide was safe and well-tolerated. CONCLUSION In obese patients with type 2 diabetes and heart failure, the use of once-weekly semaglutide was safe and clinically efficacious, improving health and functional status. Nevertheless, more strong evidence on glucagon-like peptide-1 receptor agonists in heart failure is required.
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Affiliation(s)
- Luis M. Pérez-Belmonte
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
- Servicio de Medicina Interna, Hospital Hospital Helicópteros Sanitarios, Marbella, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: Luis M. Pérez-Belmonte, ; José P. Miramontes-González,
| | - Jaime Sanz-Cánovas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
| | | | - Michele Ricci
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
| | | | - Lidia Cobos-Palacios
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
| | - Miguel A. Pérez-Velasco
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
| | - Almudena López-Sampalo
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
| | - M. Rosa Bernal-López
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Sergio Jansen-Chaparro
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
| | - José P. Miramontes-González
- Servicio de Medicina Interna, Hospital Universitario Rio Hortega, Departamento de Medicina, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
- Instituto de investigaciones biomédicas de Salamanca (IBSAL), Salamanca, Spain
- *Correspondence: Luis M. Pérez-Belmonte, ; José P. Miramontes-González,
| | - Ricardo Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
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Pan Q, Yuan M, Guo L. Exposure-Response Analysis of Cardiovascular Outcome Trials With Incretin-Based Therapies. Front Endocrinol (Lausanne) 2022; 13:893971. [PMID: 35721733 PMCID: PMC9204533 DOI: 10.3389/fendo.2022.893971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/22/2022] [Indexed: 11/17/2022] Open
Abstract
Our study aimed to evaluate the exposure-response relationship between incretin-based medications and the risk of major adverse cardiovascular events (MACE) using cardiovascular outcome trials (CVOTs). Eleven CVOTs with incretin-based medications were included. The median follow-up time, percentage of time exposure, and hazard ratio (HR) of MACE were obtained from each CVOT. The pharmacokinetic parameters of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dipeptidyl peptidase-4 inhibitor (DPP-4) were obtained from published studies. Regression analysis was performed to assess the relationship between drug exposure and MACE HR. Cutoff values were determined from the ROC curves. The linear regression results indicated that log Cmax, log AUC0-24h, and log AUCCVOT are negatively correlated with MACE HR (R2 = 0.8494, R2 = 0.8728, and R2 = 0.8372, respectively; all p < 0.0001). The relationship between drug exposure (log Cmax, log AUC0-24h, and log AUCCVOT) and MACE HR strongly corresponded with the log (inhibitor) vs. response curve (R2 = 0.8383, R2 = 0.8430, and R2 = 0.8229, respectively). The cutoff values in the ROC curves for log Cmax, log AUC0-24h, and log AUCCVOT, were 2.556, 3.868, and 6.947, respectively (all p = 0.007). A Fisher's exact test revealed that these cutoff values were significantly related to cardiovascular benefits (all p < 0.05). Our study revealed a linear exposure-response relationship between drug exposure and MACE HR. We conclude that the cardiovascular benefits of incretin-based therapies may occur with higher doses of GLP-1 RAs and with increased exposure.
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Affiliation(s)
- Qi Pan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Mingxia Yuan
- Department of Endocrinology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
- *Correspondence: Lixin Guo,
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