ACADEMIC AND RESEARCH PEER-REVIEWED MEDICAL JOURNALISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
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The Influence of Empagliflozin on Vascular Age and Key Cardiovascular Risk Factors in Type 2 Diabetes Mellitus Patients

DOI:10.31550/1727-2378-2018-152-8-6-11
Bibliography link: Nedogoda S.V., Palashkin R.V., Barykina I.N., Salasyuk A.S., Chumachek E.V., Smirnova V.O., Popova E.A. The Influence of Empagliflozin on Vascular Age and Key Cardiovascular Risk Factors in Type 2 Diabetes Mellitus Patients. Doctor.Ru. 2018; 8(152): 6–11. DOI: 10.31550/1727-2378-2018-152-8-6-11
25 October 09:42

Study Objective: To assess the potential angioprotective effects of empagliflozin, a sodium glucose cotransporter 2 inhibitor, in type 2 diabetes mellitus (T2DM) patients previously treated with metformin only.

Study Design: This was an open-label study.

Materials and Methods: Fifty patients with metabolic syndrome and T2DM took part in a 24-week study. The effects of empagliflozin on vascular stiffness, central hemodynamics, laboratory parameters, and vascular age, calculated using the SCORE scale, were assessed in these patients.

Study Results: After the treatment regimen was fortified with empagliflozin, the target glycated hemoglobin (HbA1c) level was achieved in 88% of the patients. A number of parameters were reduced, including anthropometric measurements (body weight by 3.65%, waist circumference by 1.93%, body mass index by 3.8%; p < 0.05 for all parameters) and laboratory markers of vascular ageing (HbA1c by 10.13%, total cholesterol by 8%, low-density lipoprotein cholesterol by 7.6%, leptin by 17.8%, Homeostatic Model Assessment for Insulin Resistance by 24.13%, and high-sensitivity C-reactive protein by 34.77%; p < 0.05 for all parameters). There was a significant reduction in the parameters of vascular stiffness (carotid-femoral pulse wave velocity by 8.88%) and central hemodynamics (augmentation index by 6.55% and central pulse pressure by 7.8%). Empagliflozin, however, does not significantly change vascular age calculated using the SCORE scale, because glucose metabolism parameters and T2DM status are not used in this scale, which is one of its major limitations.

Conclusion: In T2DM patients who have not achieved target HbA1c levels, empagliflozin as an additional therapy improves HbA1c levels and provides good angioprotection.

S.V. Nedogoda — Volgograd State Medical University, Russian Ministry of Health. E-mail: nedogodasv@rambler.ru

R.V. Palashkin — Volgograd State Medical University, Russian Ministry of Health. E-mail: oldgodlor@yandex.ru

I.N. Barykina — Volgograd State Medical University, Russian Ministry of Health. E-mail: irinbarykin@yandex.ru

A.S. Salasyuk — Volgograd State Medical University, Russian Ministry of Health. E-mail: solarheart7@gmail.com

E.V. Chumachek — Volgograd State Medical University, Russian Ministry of Health. E-mail: elena-chumachek@yandex.ru

V.O. Smirnova — Volgograd State Medical University, Russian Ministry of Health. E-mail: 3asabird@inbox.ru

E.A. Popova — Volgograd State Medical University, Russian Ministry of Health. E-mail: cutting_saw@mail.ru

Доктор.ру
25 October 09:42
LITERATURE
  1. Nilsson P. Early vascular aging syndrome: background and proposed definitions. Clin. Invest. 2011; 1(11): 1523–31. DOI: 10.4155/CLI.11.141
  2. Kotsis V., Stabouli S., Karafillis I., Nilsson P. Early vascular aging and the role of central blood pressure. J. Hypertens. 2011; 29(10): 1847–53. DOI: 10.1097/HJH.0b013e32834a4d9f
  3. Vlachopoulos C., Aznaouridis K., Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J. Am. Coll. Cardiol. 2010; 55(13): 1318–27. DOI: 10.1016/j.jacc.2009.10.061
  4. Vlachopoulos C., Xaplanteris P., Aboyans V., Brodmann M., Cífková R., Cosentino F. et al. The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation: Endorsed by the Association for Research into Arterial Structure and Physiology (ARTERY) Society. Atherosclerosis. 2015; 241(2): 507–32. DOI: 10.1016/j.atherosclerosis.2015.05.007
  5. Nilsson P.M. Early vascular ageing — a concept in development. Eur. Endocrinol. 2015; 11(1): 26. DOI: 10.17925/EE.2015.11.01.26
  6. Ben-Shlomo Y., Spears M., Boustred C., May M., Anderson S.G., Benjamin E.J. et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J. Am. Coll. Cardiol. 2014; 63(7): 636–46. DOI: 10.1016/j.jacc.2013.09.063
  7. Nilsson P.M. Vascular age: how can it be determined? What are its clinical applications? Medicographia. 2015; 37(4): 454–60.
  8. Guimaraes Cunha P., Boutouyrie P., Nilsson P.M., Laurent S. Early vascular ageing (EVA): definitions and clinical applicability. Curr. Hypertens. Rev. 2017; 13(1): 8–15. DOI: 10.2174/1573402113666170413094319
  9. Mourad J., Michault A., Le Jeune S., Lopez-Sublet M., Le Clesiau H. Evaluation of vascular age and its contributors in the general population: Pp. 19.238. J. Hypertens. 2010; 28: e320.
  10. Botto F., Obregon S., Di Leva A., Koretzky M., Forcada P., Brandani L. et al. Еlevated prevalence of early vascular aging in young adults in Latin America: a call for action? OPTIMO study results. J. Hum. Hypertens. 2018; 32(3): 219–27.
  11. Scuteri A., Cunha P.G., Rosei E.A., Badariere J., Bekaert S., Cockcroft J.R. et al. Arterial stiffness and influences of the metabolic syndrome: a cross-countries study. Atherosclerosis. 2014; 233(2): 654–60. DOI: 10.1016/j.atherosclerosis.2014.01.041
  12. Kannl W., McGee D.L. Diabetes and cardiovascular risk factors: the Framingham study. Circulation. 1979; 59(1): 8–13.
  13. Booth G.L., Kapral M.K., Fung K., Tu J.V. Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study. Lancet. 2006; 368(9529): 29–36. DOI: 10.1016/S0140-6736(06)68967-8
  14. Gottsäter M., Östling G., Persson M., Engström G., Melander O., Nilsson P.M. Non-hemodynamic predictors of arterial stiffness after 17 years of follow-up: the Malmö Diet and Cancer study. J. Hypertens. 2015; 33(5): 957–65. DOI: 10.1097/HJH.0000000000000520
  15. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998; 352(9131): 854–65.
  16. Action to Control Cardiovascular Risk in Diabetes Study Group; Gerstein H.C., Miller M.E., Byington R.P., Goff D.C. Jr., Bigger J.T. et al. Effects of intensive glucose lowering in type 2 diabetes. N. Engl. J. Med. 2008; 358(24): 2545–59. DOI: 10.1056/NEJMoa0802743
  17. ADVANCE Collaborative Group; Patel A., MacMahon S., Chalmers J., Neal B., Billot L. et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N. Engl. J. Med. 2008; 358(24): 2560–72. DOI: 10.1056/NEJMoa0802987
  18. Ismail-Beigi F., Moghissi E. Glycemia management and cardiovascular risk in type 2 diabetes: an evolving perspective. Endocr. Pract. 2008; 14(5): 639–43. DOI: 10.4158/EP.14.5.639
  19. Филиппов Ю.И. Стратегии лечения сахарного диабета 2 типа: почему мы не видим «Слона в посудной лавке»? Сахарный диабет. 2016; 19(4): 341–9. [Filippov Yu.I. Strategii lecheniya sakharnogo diabeta 2 tipa: pochemu my ne vidim “Slona v posudnoi lavke”? Sakharnyi diabet. 2016; 19(4): 341–9. (in Russian)]. DOI: 10.14341/DM7077
  20. Шмюэль, Л., Филиппов, Ю.И., Горелышев, А.С. Сахарный диабет 2 типа: время изменить концепцию. Сахарный диабет. 2013; 58: 91–102. [Shmyuel', L., Filippov, Yu.I., Gorelyshev, A.S. Sakharnyi diabet 2 tipa: vremya izmenit' kontseptsiyu. Sakharnyi diabet. 2013; 58: 91–102. (in Russian)]
  21. Neeland I.J., McGuire D.K., Chilton R., Crowe S., Lund S.S., Woerle H.J. et al. Empagliflozin reduces body weight and indices of adipose distribution in patients with type 2 diabetes mellitus. Diab. Vasc. Dis. Res. 2016; 13(2): 119–26. DOI: 10.1177/1479164115616901
  22. Xu L., Ota T. Emerging roles of SGLT2 inhibitors in obesity and insulin resistance: focus on fat browning and macrophage polarization. Adipocyte. 2018. 7(2): 121–8. DOI: 10.1080/21623945.2017.1413516
  23. Xu L., Nagata N., Nagashimada M., Zhuge F., Ni Y., Chen G. et al. SGLT2 inhibition by empagliflozin promotes fat utilization and browning and attenuates inflammation and insulin resistance by polarizing M2 macrophages in diet-induced obese mice. EBioMedicine. 2017; 20: 137–49. DOI: 10.1016/j.ebiom.2017.05.028
  24. Zinman B., Wanner C., Lachin J.M., Fitchett D., Bluhmki E., Hantel S. et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N. Engl. J. Med. 2015; 373(22): 2117–28. DOI: 10.1056/NEJMoa1504720
  25. Chilton R., Tikkanen I., Cannon C.P., Crowe S., Woerle H.J., Broedl U.C. et al. Effects of empagliflozin on blood pressure and markers of arterial stiffness and vascular resistance in patients with type 2 diabetes. Diabetes Obes. Metab. 2015; 17(12): 1180–93. DOI: 10.1111/dom.12572
  26. Дедов И.И., Шестакова М.В., Майоров А.Ю., ред. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. Сахарный диабет. 2017; 20(1S): 1–112. [Dedov I.I., Shestakova M.V., Maiorov A.Yu., red. Algoritmy spetsializirovannoi meditsinskoi pomoshchi bol'nym sakharnym diabetom. Sakharnyi diabet. 2017; 20(1S): 1–112. (in Russian)]. DOI: 10.14341/DM20171S8
  27. Карпов Ю.А., Сорокин Е.В. Оценка риска осложнений при артериальной гипертонии и сосудистый возраст: новые инструменты для повышения качества лечения и улучшения взаимопонимания врача и больного. Атмосфера. Новости кардиологии. 2015; 2: 18–24. [Karpov Ju.A., Sorokin E.V. Ocenka riska oslozhnenij pri arterial'noj gipertonii i sosudistyj vozrast: novye instrumenty dlja povyshenija kachestva lechenija i uluchshenija vzaimoponimanija vracha i bol'nogo. Atmosfera. Novosti kardiologii. 2015; 2: 18–24. (in Russian)]
  28. Драпкина О.М., Манджиева Б.А. Сосудистый возраст. Механизмы старения сосудистой стенки. Методы оценки сосудистого возраста. Кардиоваск. терапия и профилактика. 2014; 13(5): 74–82. [Drapkina O.M., Mandzhieva B.A. Sosudistyj vozrast. Mehanizmy starenija sosudistoj stenki. Metody ocenki sosudistogo vozrasta. Kardiovask. terapija i profilaktika. 2014; 13(5): 74–82. (in Russian)]. DOI: 10.15829/1728-8800-2014-5-74-82
  29. Карпов Ю.А., Сорокин Е.В. Влияние комбинированной гипотензивной терапии на риск сердечно-сосудистых осложнений и сосудистый возраст: результаты многоцентрового открытого исследования ADVANT’AGE. Атмосфера. Новости кардиологии. 2015; 3: 2–10. [Karpov Ju.A., Sorokin E.V. Vlijanie kombinirovannoj gipotenzivnoj terapii na risk serdechno-sosudistyh oslozhnenij i sosudistyj vozrast: rezul'taty mnogocentrovogo otkrytogo issledovanija ADVANT’AGE. Atmosfera. Novosti kardiologii. 2015; 3: 2–10. (in Russian)]
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