Insulin resistance and cardiovascular disease

Journal of International Medical Research, Год журнала: 2023, Номер 51(3)

Опубликована: Март 1, 2023

Insulin resistance (IR) and cardiovascular disease (CVD) represent two universal public health hazards, especially in today’s Western societies. A causal-effect relationship has been established that links IR with CVD. The mediating mechanisms are perplexing, under ongoing, rigorous investigation remain to be fully elucidated. is a condition encompassing hyperglycemia compensatory hyperinsulinemia. It occurs when insulin not capable of exerting its maximum effects on target tissues, including skeletal muscles, liver adipose tissue. This alteration signaling pathways results the development cardiometabolic disorders, obesity, dyslipidemia, low-grade inflammation, endothelial dysfunction hypertension, all which predisposing factors for atherosclerosis management can achieved through dietary modifications, inclusion regular exercise routines everyday life, pharmacological agents other interventions tailored each individual patient’s needs. important underline though that, although various antidiabetic drugs may improve available, no medications as yet specifically approved treatment IR. narrative review will focus current scientific clinical evidence pertaining IR, connecting CVD, well plausible strategies holistic, personalized approach management.

Язык: Английский

---

SGLT-2 inhibitors and in-stent restenosis-related events after acute myocardial infarction: an observational study in patients with type 2 diabetes

BMC Medicine, Год журнала: 2023, Номер 21(1)

Опубликована: Фев. 24, 2023

No study evaluated the incidence of intra-stent restenosis (ISR)-related events in patients with type 2 diabetes (T2DM) and acute myocardial infarction (AMI) treated or not sodium/glucose cotransporter inhibitors (SGLT2i).We recruited 377 T2DM AMI undergoing percutaneous coronary intervention (PCI). Among them, 177 were SGLT2 before PCI. The primary outcome was major adverse cardiovascular (MACE) defined as cardiac death, re-infarction, heart failure related to ISR. In without ISR, minimal lumen area diameter assessed by CT-angiography at 1-year follow-up.Glycemic control similar SGLT2i-treated never SGLT2i-users. ISR-related MACE higher SGLT2i-users compared patients, an effect independent glycemic status (HR = 0.418, 95% CI 0.241-0.725, P 0.002) observed also subgroup HbA1c < 7% 0.393, 0.157-0.984, 0.027). event, stent patency greater follow-up.SGLT2i treatment is associated a reduced events, independently control.

Язык: Английский

---

Impact of SGLT2-inhibitors on contrast-induced acute kidney injury in diabetic patients with acute myocardial infarction with and without chronic kidney disease: Insight from SGLT2-I AMI PROTECT registry

Diabetes Research and Clinical Practice, Год журнала: 2023, Номер 202, С. 110766 - 110766

Опубликована: Июнь 3, 2023

Язык: Английский

---

Dapagliflozin reduces systemic inflammation in patients with type 2 diabetes without known heart failure

Cardiovascular Diabetology, Год журнала: 2024, Номер 23(1)

Опубликована: Июнь 7, 2024

Abstract Objective Sodium glucose cotransporter 2 (SGLT2) inhibitors significantly improve cardiovascular outcomes in diabetic patients; however, the mechanism is unclear. We hypothesized that dapagliflozin improves cardiac via beneficial effects on systemic and inflammation fibrosis. Research design methods This randomized placebo-controlled clinical trial enrolled 62 adult patients (mean age 62, 17% female) with type diabetes (T2D) without known heart failure. Subjects were to 12 months of daily 10 mg or placebo. For all patients, blood/plasma samples magnetic resonance imaging (CMRI) obtained at time randomization end months. Systemic was assessed by plasma IL-1B, TNFα, IL-6 ketone levels PBMC mitochondrial respiration, an emerging marker sterile inflammation. Global myocardial strain feature tracking; fibrosis T1 mapping calculate extracellular volume fraction (ECV); tissue T2 mapping. Results Between baseline 12-month point, IL-1B reduced (− 1.8 pg/mL, P = 0.003) while ketones increased (0.26 mM, 0.0001) dapagliflozin. maximal oxygen consumption rate (OCR) decreased over period placebo group but did not change receiving 158.9 pmole/min/10 6 cells, 0.0497 vs. − 5.2 0.41), a finding consistent anti-inflammatory effect SGLT2i. strain, ECV relaxation both study groups. Clinical Trial.gov Registration NCT03782259.

Язык: Английский

---

Integrated Management of Cardiovascular–Renal–Hepatic–Metabolic Syndrome: Expanding Roles of SGLT2is, GLP-1RAs, and GIP/GLP-1-RAs

Biomedicines, Год журнала: 2025, Номер 13(1), С. 135 - 135

Опубликована: Янв. 8, 2025

Cardiovascular-Kidney-Metabolic syndrome, introduced by the American Heart Association in 2023, represents a complex and interconnected spectrum of diseases driven shared pathophysiological mechanisms. However, this framework notably excludes liver-an organ fundamental to metabolic regulation. Building on concept, Cardiovascular-Renal-Hepatic-Metabolic (CRHM) syndrome incorporates liver's pivotal role disease spectrum, particularly through its involvement via dysfunction-associated steatotic liver (MASLD). Despite increasing prevalence CRHM unified management strategies remain insufficiently explored. This review addresses following critical question: How can novel anti-diabetic agents, including sodium-glucose cotransporter-2 inhibitors (SGLT2is), glucagon-like peptide-1 receptor agonists (GLP-1RAs), dual gastric inhibitory polypeptide (GIP)/GLP-1RA, offer an integrated approach managing beyond boundaries traditional specialties? By synthesizing evidence from landmark clinical trials, we highlight paradigm-shifting potential these therapies. SGLT2is, such as dapagliflozin empagliflozin, have emerged cornerstone guideline-directed treatments for heart failure (HF) chronic kidney (CKD), providing benefits that extend glycemic control are independent diabetes status. GLP-1RAs, e.g., semaglutide, transformed obesity enabling weight reductions exceeding 15% improving outcomes atherosclerotic cardiovascular (ASCVD), diabetic CKD, HF, MASLD. Additionally, tirzepatide, GIP/GLP-1RA, enables unprecedented loss (>20%), reduces risk over 90%, improves HF with preserved ejection fraction (HFpEF), MASLD, obstructive sleep apnea. moving organ-specific approach, propose integrates agents into holistic syndrome. paradigm shift moves away fragmented, organ-centric toward more fostering collaboration across specialties marking progress precision cardiometabolic medicine.

Язык: Английский

---

Mechanisms of benefits of sodium-glucose cotransporter 2 inhibitors in heart failure with preserved ejection fraction

European Heart Journal, Год журнала: 2023, Номер 44(37), С. 3640 - 3651

Опубликована: Июнь 13, 2023

For decades, heart failure with preserved ejection fraction (HFpEF) proved an elusive entity to treat. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have recently been shown reduce the composite of hospitalization or cardiovascular death in patients HFpEF landmark DELIVER and EMPEROR-Preserved trials. While improvements blood sugar, pressure, attenuation kidney disease progression all may play some role, preclinical translational research identified additional mechanisms these agents. The SGLT2 intriguingly induce a nutrient-deprivation hypoxic-like transcriptional paradigm, increased ketosis, erythropoietin, autophagic flux addition altering iron homeostasis, which contribute improved cardiac energetics function. These agents also epicardial adipose tissue alter adipokine signalling, role reductions inflammation oxidative stress observed inhibition. Emerging evidence indicates that drugs impact cardiomyocyte ionic homeostasis although whether this is through indirect via direct, off-target effects on other ion channels has yet be clearly characterized. Finally, myofilament stiffness as well extracellular matrix remodelling/fibrosis heart, improving diastolic established themselves robust, disease-modifying therapies recent trial results are incorporated into clinical guidelines, will likely become foundational therapy HFpEF.

Язык: Английский

---

Targeting high glucose-induced epigenetic modifications at cardiac level: the role of SGLT2 and SGLT2 inhibitors

Cardiovascular Diabetology, Год журнала: 2023, Номер 22(1)

Опубликована: Фев. 2, 2023

Abstract Background Sodium-glucose co-transporters (SGLT) inhibitors (SGLT2i) showed many beneficial effects at the cardiovascular level. Several mechanisms of action have been identified. However, no data on their capability to act via epigenetic were reported. Therefore, this study aimed investigate ability SGLT2 induce protective level by acting DNA methylation. Methods To better clarify issue, empagliflozin (EMPA) hyperglycemia-induced modifications evaluated in human ventricular cardiac myoblasts AC16 exposed hyperglycemia for 7 days. EMPA methylation NF-κB, SOD2, and IL-6 genes high glucose analyzed pyrosequencing-based analysis. Modifications gene expression NF-κB SOD2 confirmed response a transient silencing same cellular model. Moreover, chromatin immunoprecipitation followed quantitative PCR was performed evaluate occupancy TET2 across investigated regions promoters. Results Seven days treatment induced significant demethylation promoter NF-kB with consequent mRNA both genes. The observed mediated increased binding CpGs island Indeed, prevented HG-induced changes reducing region counteracted altered expression. regions, thus suggesting role as potential target anti-inflammatory antioxidant effect cardiomyocytes. Conclusions In conclusion, our results demonstrated that EMPA, mainly SGLT2, provided evidence new mechanism which SGLT2i can exert cardio-beneficial effects. Graphical

Язык: Английский

---

Targeting inflammatory signaling pathways with SGLT2 inhibitors: Insights into cardiovascular health and cardiac cell improvement

Current Problems in Cardiology, Год журнала: 2024, Номер 49(5), С. 102524 - 102524

Опубликована: Март 16, 2024

Язык: Английский

---

Sodium-glucose co-transporter-2 inhibitors in patients treated with immune checkpoint inhibitors

Cardio-Oncology, Год журнала: 2024, Номер 10(1)

Опубликована: Янв. 11, 2024

Abstract Background Immune checkpoint inhibitors (ICIs) have revolutionized the prognosis of cancer. Diabetes mellitus (DM) has been shown to a negative effect on patients treated with ICIs. Sodium-glucose cotransporter 2 (SGLT2i) are effective antidiabetic therapies associated reduced all-cause mortality and cardiovascular (CV) outcomes. Objective To evaluate prognostic value SGLT2i cardiotoxicity among Methods We performed retrospective analysis diagnosed cancer type DM (DM2) ICIs at our center. Patients were divided into two groups according baseline treatment or without SGLT2i. The primary endpoint was secondary MACE, including myocarditis, acute coronary syndrome, heart failure, arrhythmia. Results cohort included 119 patients, 24 (20%) assigned group. Both exhibited comparable prevalence cardiac risk factors, although group displayed higher incidence ischemic disease. Over median follow-up 28 months, 61 (51%) died, significantly lower rate in (21% vs. 59%, p = 0.002). While there no significant differences we observed zero cases myocarditis atrial fibrillation SGLT2i, compared 6 non-SGLT2i Conclusions therapy DM2 Further studies needed understand mechanism its benefit cardiotoxicity. Graphical

Язык: Английский

---

The clinical benefits of sodium–glucose cotransporter type 2 inhibitors in people with gout

Nature Reviews Rheumatology, Год журнала: 2024, Номер 20(4), С. 216 - 231

Опубликована: Март 12, 2024

Язык: Английский

---