Why the study?
Little was known about the effects of SGLT2 inhibitors on atherosclerosis when initiated in the early in-hospital phase after acute coronary syndrome.
Does dapagliflozin 10 mg improve endothelial function and atherosclerosis biomarkers in patients with acute coronary syndrome?
Observational (n=113)
No
Does dapagliflozin 10 mg improve endothelial function and atherosclerosis biomarkers in patients with acute coronary syndrome?
Initiation of dapagliflozin 10 mg during the acute phase of acute coronary syndrome is associated with significant improvement in endothelial function at 90 days in both diabetic and non-diabetic patients.
May suggest endothelial benefit with dapagliflozin post-ACS; hypothesis-generating and requires randomized confirmation before practice change.
Little is known about the effects of sodium-glucose co-transporter 2 inhibitors (SGLT2i) on atherosclerosis. We aimed to determine if a 90-day intake of Dapagliflozin could improve atherosclerosis biomarkers (namely endothelial function assessed by flow-mediated dilatation [FMD] and carotid intima-media thickness [CIMT]) in diabetic and non-diabetic acute coronary syndrome (ACS) patients when initiated in the early in-hospital phase. ATH-SGLT2i was a prospective, single-center, observational trial that included 113 SGLT2i naive patients who were admitted for ACS and who were prescribed Dapagliflozin at a fixed dose of 10 mg during their hospital stay for either type 2 diabetes or for heart failure. After 90 days of follow-up, subjects who had a continuous intake of Dapagliflozin formed the SGLT2i group, while patients who did not take Dapagliflozin formed the non-SGLT2i group. In each of these main study groups, we considered diabetic and non-diabetic subgroups. The primary endpoint was the difference in between baseline and 90 days in FMD (∆FMD) and in FMD rate (∆FMD%). The secondary outcome was change in CIMT (∆CIMT). We enrolled 54 patients in the SGLT2i group aged 59 ± 9 years (70.4% males) which 30 were diabetics, and 59 in the non-SGLT2i group aged 63 ± 11 years (78% males) which 34 were diabetics. After 90 days, ∆FMD and ∆ FMD% were higher in the SGLT2i group in comparison with the non-SGLT2i group (0.05 ± 0.15 vs -0.05 ± 0.11, P < .001 and 1.78 ± 3.63 vs -0.88 ± 4, P < .001). Within the SGLT2i group, the improvement of FMD% was higher in non-diabetic patients (2.85 ± 3.46 vs 0.9 ± 3.59, P = .05). Multivariate analysis showed that Dapagliflozin intake was independently associated with FMD% improvement (HR = 2.24). After 90 days, CIMT showed no significant difference between the SGLT2i and the non-SGLT2i groups. In this pilot study, a 90-day intake of Dapagliflozin at the fixed dose of 10 mg started in the acute phase of an ACS, was associated with endothelial function improvement in diabetic and non-diabetic patients.
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Mghaieth et al. (2024) conducted an observational in acute coronary syndrome (n=113). Dapagliflozin vs. No Dapagliflozin (non-SGLT2i group) was evaluated on difference between baseline and 90 days in FMD (∆FMD) and in FMD rate (∆FMD%) (HR 2.24, p=<.001).
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