Exploration of the Effects of SGLT-2 Inhibitors and GLP-1 Receptor Agonists on Coronary Inflammation in Type 2 Diabetes Patients Based on the Peri-Coronary Fat Attenuation Index.

Q: What are the key findings of this study?

Combination therapy with SGLT-2 inhibitors and GLP-1 receptor agonists was independently associated with a significant reduction in the left anterior descending artery peri-coronary fat attenuation index compared to non-users.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Type 2 diabetes mellitus (n=292). Intervention: SGLT-2 inhibitor and GLP-1 receptor agonist combination therapy vs. Non-users (no SGLT-2i or GLP-1RA therapy). Primary outcome: Peri-coronary fat attenuation index (FAI) in the left anterior descending artery (LAD) (MD -3.054, 95% CI -5.625 to -0.484, p=0.020).

Q: What does this research mean for the field?

Combination therapy with SGLT-2 inhibitors and GLP-1 receptor agonists is independently associated with a significant reduction in peri-coronary fat attenuation index, indicating reduced coronary artery inflammation compared to non-use in type 2 diabetes patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Tianxing Wang; Yanhong Li; Wenjing Yao; Sijin Zhang; Sihan Chi; Yuxing Wang; Ce Wang; 党懿; Feifei Zhang

doi:10.31083/rcm47415

May 1, 2026

Exploration of the Effects of SGLT-2 Inhibitors and GLP-1 Receptor Agonists on Coronary Inflammation in Type 2 Diabetes Patients Based on the Peri-Coronary Fat Attenuation Index.

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Key result

Dual SGLT2i and GLP-1RA therapy linked to ~3-point lower LAD fat attenuation index vs. non-users.

MD -3.054
95% CI -5.625 to -0.484
P=0.020
n=292

Figures

Why the study?

This study aimed to investigate the association between combination therapy with SGLT-2 inhibitors and GLP-1 receptor agonists and coronary artery inflammation, assessed by peri-coronary FAI, in patients with T2DM.

Does combination therapy with SGLT-2 inhibitors and GLP-1 receptor agonists reduce coronary inflammation assessed by peri-coronary fat attenuation index in patients with type 2 diabetes mellitus?

Key Points

To investigate whether combined treatment with SGLT-2 inhibitors and GLP-1 receptor agonists is associated with reduced coronary artery inflammation, evaluated via the peri-coronary fat attenuation index (FAI), in patients with type 2 diabetes mellitus.
Retrospective analysis of N = 292 patients with type 2 diabetes mellitus who underwent coronary computed tomography angiography (CCTA) at Hebei General Hospital.
Patients were stratified into three groups: non-users of SGLT-2i/GLP-1RA (n = 125), monotherapy (n = 124), and combination therapy (n = 43).
Intergroup FAI differences across the LAD, LCX, and RCA were analyzed using one-way ANOVA and adjusted via multivariate linear regression models.
Compared with non-users, combination therapy showed significantly lower peri-coronary FAI in the LAD (–81.86 ± 6.79 vs. –78.96 ± 6.67, p = 0.020) and LCX (–76.57 ± 6.71 vs. –73.27 ± 8.11, p = 0.016), as well as significantly lower LCX FAI than monotherapy (–76.57 ± 6.71 vs. –73.09 ± 7.65, 95% CI: –6.17 to 0.79, p = 0.011).
Multivariate regression (Model 2) demonstrated that combination therapy was independently associated with lower FAI in the LAD (b = –3.054, 95% CI: –5.625 to –0.484, p = 0.020), LCX (b = –3.602, 95% CI: –6.446 to –0.758, p = 0.013), and RCA (b = –2.745, 95% CI: –5.313 to –0.177, p = 0.036).
Subgroup analysis identified a significant interaction between treatment regimen and sex for LCX FAI (p-interaction = 0.038), with combination therapy showing a significant reduction among male patients (b = –3.433, 95% CI: –6.864 to –0.001, p = 0.048).

Study Design

Type

Observational (n=292)

Multicenter

No

Structured PICO

Does combination therapy with SGLT-2 inhibitors and GLP-1 receptor agonists reduce coronary inflammation assessed by peri-coronary fat attenuation index in patients with type 2 diabetes mellitus?

P

Population

292 overweight or obese patients with type 2 diabetes and no prior cardiovascular disease who underwent coronary computed tomography angiography.

E

Exposure

Combination therapy with SGLT-2 inhibitors (dapagliflozin 10 mg or empagliflozin 10 mg daily) and GLP-1 receptor agonists (semaglutide 0.5-1.0 mg weekly or liraglutide 0.6-1.8 mg daily) for ≥ 6 months.

C

Comparator

Two groups: (1) Non-users (n=125) not receiving SGLT-2i or GLP-1RA therapy; (2) Monotherapy (n=124) receiving either SGLT-2i or GLP-1RA alone.

O

Outcome

Coronary artery inflammation, assessed by the peri-coronary fat attenuation index (FAI) measured via CCTA in the left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA).surrogate

Main Result

Mean Difference: -3.054 (95% CI -5.625–-0.484)

Absolute Event Rate: -81.86% vs -78.96%

p-value: p=0.020

Limitations

Small sample size, particularly in the combination therapy subgroup
Retrospective study design subject to selection bias and unmeasured confounders (e.g., diet, physical activity)
Inability to distinguish the independent effects of SGLT-2i and GLP-1RA within the monotherapy group
Exclusion of patients with a BMI < 24 kg/m2 restricts generalization to normal-weight patients
Lack of epicardial fat volume and inflammatory cytokine measurements
Limited sample size, particularly in specific subgroups such as female patients receiving combination therapy
Retrospective observational design requiring future validation in large-sample prospective studies

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Implication

May suggest reduced coronary inflammation in T2DM; hypothesis-generating and requires prospective trials before practice change.

Abstract

Background: The peri-coronary fat attenuation index (FAI) is a novel imaging biomarker of inflammation. This study aimed to investigate the association between combination therapy with sodium-glucose transporter 2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) and coronary artery inflammation, as assessed by the peri-coronary FAI, in patients with type 2 diabetes mellitus (T2DM). Methods: This retrospective analysis included 292 patients with T2DM who underwent coronary computed tomography angiography (CCTA) at Hebei General Hospital. Patients were divided into three groups: (1) non-SGLT-2i/GLP-1RA users (non-users, n = 125): Patients not receiving SGLT-2i or GLP-1RA therapy; (2) SGLT-2i/GLP-1RA monotherapy group (mono-tx, n = 124): Patients treated with either SGLT-2i or GLP-1RA alone; (3) SGLT-2i + GLP-1RA combination therapy group (combo-tx, n = 43): Patients receiving concurrent SGLT-2i and GLP-1RA therapy. Clinical parameters, laboratory biomarkers, and the peri-coronary FAI of patients were collected and comparatively analyzed among the three groups. Finally, multivariate linear regression models were constructed to elucidate the independent association between combined GLP-1RA and SGLT-2i therapy and the peri-coronary FAI. Results: One-way analysis of variance (ANOVA) revealed significant differences in the peri-coronary FAI among the three therapy groups. Specifically, compared with the non-user group, the combo-tx group had significantly lower peri-coronary FAI values in the left circumflex artery (LCX) and left anterior descending artery (LAD). Compared with the mono-tx group, the combo-tx group also had a significantly lower LCX FAI. Multivariate regression analysis further confirmed that combination therapy was independently associated with a lower FAI in the LAD, LCX, and right coronary artery (RCA). Subgroup analysis revealed a significant interaction by sex in the association between treatment regimen and LCX FAI. Conclusion: The combined use of SGLT-2 inhibitors and GLP-1RAs may be associated with a decrease in the peri-coronary FAI in patients with T2DM, suggesting a potential role in reducing coronary inflammation. Thus, this combination therapy might offer advantages over monotherapy.

Discussion

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Cite This Study

Wang et al. (2026) conducted an observational in Type 2 diabetes mellitus (n=292). SGLT-2 inhibitor and GLP-1 receptor agonist combination therapy vs. Non-users (no SGLT-2i or GLP-1RA therapy) was evaluated on Peri-coronary fat attenuation index (FAI) in the left anterior descending artery (LAD) (MD -3.054, 95% CI -5.625 to -0.484, p=0.020). Combination therapy with SGLT-2 inhibitors and GLP-1 receptor agonists was independently associated with a significant reduction in the left anterior descending artery peri-coronary fat attenuation index compared to non-users.

synapsesocial.com/papers/6a23bad471a5da9775e7682b https://doi.org/10.31083/rcm47415

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Exploration of the Effects of SGLT-2 Inhibitors and GLP-1 Receptor Agonists on Coronary Inflammation in Type 2 Diabetes Patients Based on the Peri-Coronary Fat Attenuation Index.

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Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Exploration of the Effects of SGLT-2 Inhibitors and GLP-1 Receptor Agonists on Coronary Inflammation in Type 2 Diabetes Patients Based on the Peri-Coronary Fat Attenuation Index.

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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