Empagliflozin confers reno‐protection in acute myocardial infarction and type 2 diabetes mellitus
Abstract Aims Although the reno‐protective effects of sodium–glucose cotransporter 2 inhibitors are known in patients with heart failure or type 2 diabetes mellitus (T2DM), this effect has not been confirmed in patients with acute myocardial infarction (AMI). Methods and results The prospective, mul...
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Language: | English |
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Wiley
2021-10-01
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Series: | ESC Heart Failure |
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Online Access: | https://doi.org/10.1002/ehf2.13509 |
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doaj-22720d5b533447e2bdb3a0064ed8215f |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kosuke Mozawa Yoshiaki Kubota Yu Hoshika Shuhei Tara Yukichi Tokita Kenji Yodogawa Yu‐ki Iwasaki Takeshi Yamamoto Hitoshi Takano Yayoi Tsukada Kuniya Asai Masaaki Miyamoto Yasushi Miyauchi Eitaro Kodani Mitsunori Maruyama Jun Tanabe Wataru Shimizu |
spellingShingle |
Kosuke Mozawa Yoshiaki Kubota Yu Hoshika Shuhei Tara Yukichi Tokita Kenji Yodogawa Yu‐ki Iwasaki Takeshi Yamamoto Hitoshi Takano Yayoi Tsukada Kuniya Asai Masaaki Miyamoto Yasushi Miyauchi Eitaro Kodani Mitsunori Maruyama Jun Tanabe Wataru Shimizu Empagliflozin confers reno‐protection in acute myocardial infarction and type 2 diabetes mellitus ESC Heart Failure Acute myocardial infarction Empagliflozin Estimated glomerular filtration rate Sodium–glucose cotransporter 2 inhibitor Type 2 diabetes mellitus Uric acid |
author_facet |
Kosuke Mozawa Yoshiaki Kubota Yu Hoshika Shuhei Tara Yukichi Tokita Kenji Yodogawa Yu‐ki Iwasaki Takeshi Yamamoto Hitoshi Takano Yayoi Tsukada Kuniya Asai Masaaki Miyamoto Yasushi Miyauchi Eitaro Kodani Mitsunori Maruyama Jun Tanabe Wataru Shimizu |
author_sort |
Kosuke Mozawa |
title |
Empagliflozin confers reno‐protection in acute myocardial infarction and type 2 diabetes mellitus |
title_short |
Empagliflozin confers reno‐protection in acute myocardial infarction and type 2 diabetes mellitus |
title_full |
Empagliflozin confers reno‐protection in acute myocardial infarction and type 2 diabetes mellitus |
title_fullStr |
Empagliflozin confers reno‐protection in acute myocardial infarction and type 2 diabetes mellitus |
title_full_unstemmed |
Empagliflozin confers reno‐protection in acute myocardial infarction and type 2 diabetes mellitus |
title_sort |
empagliflozin confers reno‐protection in acute myocardial infarction and type 2 diabetes mellitus |
publisher |
Wiley |
series |
ESC Heart Failure |
issn |
2055-5822 |
publishDate |
2021-10-01 |
description |
Abstract Aims Although the reno‐protective effects of sodium–glucose cotransporter 2 inhibitors are known in patients with heart failure or type 2 diabetes mellitus (T2DM), this effect has not been confirmed in patients with acute myocardial infarction (AMI). Methods and results The prospective, multicentre, randomized, double‐blind, placebo‐controlled EMBODY trial investigated patients with AMI and T2DM in Japan. The eligible patients included adults aged 20 years or older, diagnosed with AMI and T2DM, and who could be discharged within 2–12 weeks after the onset of AMI. One hundred and five patients were randomized (1:1) to receive once daily 10 mg empagliflozin or placebo within 2 weeks of AMI onset. In this sub‐analysis, we investigated the time course of renal functional parameters such as serum creatinine levels and estimated glomerular filtration rate (eGFR) from baseline to Weeks 4, 12, and 24. Ninety‐six patients (64 ± 11 years, 78 male) were included in the full analysis (n = 46 and 50 in the empagliflozin and placebo groups, respectively). We used serum creatinine and eGFR as indicators of renal function. In the placebo group, eGFR decreased from 66.14 mL/min/1.73 m2 at baseline to 62.77 mL/min/1.73 m2 by Week 24 (P = 0.023) but remained unchanged in the empagliflozin group (from 64.60 to 64.36 mL/min/1.73 m2, P = 0.843). In the latter group, uric acid improved from 5.8 mg/dL at baseline to 4.9 mg/dL at Week 24 (P < 0.001). In the earlier analysis of 56 patients with eGFR ≥ 60 mL/min/1.73 m2, the eGFR decreased and the serum creatinine increased from baseline to 24 weeks in the placebo group, significantly different to the empagliflozin group (−6.61 vs. +0.22 mL/min/1.73 m2, P = 0.008 and +0.063 vs. −0.001 mg/dL, P = 0.030, respectively). The changes in serum creatinine and eGFR from baseline to Week 24 were significantly correlated with those in uric acid in the placebo group (r = 0.664, P < 0.001 and r = −0.675, P < 0.001, respectively) but not in the empagliflozin group. Conclusions Empagliflozin prevented the kidney functional decline in patients with AMI and T2DM, especially those with baseline eGFR ≥ 60 mL/min/1.73 m2. Early administration of sodium–glucose cotransporter 2 inhibitors in these patients is considered desirable for renal protection. |
topic |
Acute myocardial infarction Empagliflozin Estimated glomerular filtration rate Sodium–glucose cotransporter 2 inhibitor Type 2 diabetes mellitus Uric acid |
url |
https://doi.org/10.1002/ehf2.13509 |
work_keys_str_mv |
AT kosukemozawa empagliflozinconfersrenoprotectioninacutemyocardialinfarctionandtype2diabetesmellitus AT yoshiakikubota empagliflozinconfersrenoprotectioninacutemyocardialinfarctionandtype2diabetesmellitus AT yuhoshika empagliflozinconfersrenoprotectioninacutemyocardialinfarctionandtype2diabetesmellitus AT shuheitara empagliflozinconfersrenoprotectioninacutemyocardialinfarctionandtype2diabetesmellitus AT yukichitokita empagliflozinconfersrenoprotectioninacutemyocardialinfarctionandtype2diabetesmellitus AT kenjiyodogawa empagliflozinconfersrenoprotectioninacutemyocardialinfarctionandtype2diabetesmellitus AT yukiiwasaki empagliflozinconfersrenoprotectioninacutemyocardialinfarctionandtype2diabetesmellitus AT takeshiyamamoto empagliflozinconfersrenoprotectioninacutemyocardialinfarctionandtype2diabetesmellitus AT hitoshitakano empagliflozinconfersrenoprotectioninacutemyocardialinfarctionandtype2diabetesmellitus AT yayoitsukada empagliflozinconfersrenoprotectioninacutemyocardialinfarctionandtype2diabetesmellitus AT kuniyaasai empagliflozinconfersrenoprotectioninacutemyocardialinfarctionandtype2diabetesmellitus AT masaakimiyamoto empagliflozinconfersrenoprotectioninacutemyocardialinfarctionandtype2diabetesmellitus AT yasushimiyauchi empagliflozinconfersrenoprotectioninacutemyocardialinfarctionandtype2diabetesmellitus AT eitarokodani empagliflozinconfersrenoprotectioninacutemyocardialinfarctionandtype2diabetesmellitus AT mitsunorimaruyama empagliflozinconfersrenoprotectioninacutemyocardialinfarctionandtype2diabetesmellitus AT juntanabe empagliflozinconfersrenoprotectioninacutemyocardialinfarctionandtype2diabetesmellitus AT watarushimizu empagliflozinconfersrenoprotectioninacutemyocardialinfarctionandtype2diabetesmellitus |
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doaj-22720d5b533447e2bdb3a0064ed8215f2021-10-08T11:50:38ZengWileyESC Heart Failure2055-58222021-10-01854161417310.1002/ehf2.13509Empagliflozin confers reno‐protection in acute myocardial infarction and type 2 diabetes mellitusKosuke Mozawa0Yoshiaki Kubota1Yu Hoshika2Shuhei Tara3Yukichi Tokita4Kenji Yodogawa5Yu‐ki Iwasaki6Takeshi Yamamoto7Hitoshi Takano8Yayoi Tsukada9Kuniya Asai10Masaaki Miyamoto11Yasushi Miyauchi12Eitaro Kodani13Mitsunori Maruyama14Jun Tanabe15Wataru Shimizu16Department of Cardiovascular Medicine Nippon Medical School 1‐1‐5, Sendagi, Bunkyo‐ku Tokyo 113‐0022 JapanDepartment of Cardiovascular Medicine Nippon Medical School 1‐1‐5, Sendagi, Bunkyo‐ku Tokyo 113‐0022 JapanDepartment of Cardiovascular Medicine Nippon Medical School 1‐1‐5, Sendagi, Bunkyo‐ku Tokyo 113‐0022 JapanDepartment of Cardiovascular Medicine Nippon Medical School 1‐1‐5, Sendagi, Bunkyo‐ku Tokyo 113‐0022 JapanDepartment of Cardiovascular Medicine Nippon Medical School 1‐1‐5, Sendagi, Bunkyo‐ku Tokyo 113‐0022 JapanDepartment of Cardiovascular Medicine Nippon Medical School 1‐1‐5, Sendagi, Bunkyo‐ku Tokyo 113‐0022 JapanDepartment of Cardiovascular Medicine Nippon Medical School 1‐1‐5, Sendagi, Bunkyo‐ku Tokyo 113‐0022 JapanDepartment of Cardiovascular Medicine Nippon Medical School 1‐1‐5, Sendagi, Bunkyo‐ku Tokyo 113‐0022 JapanDepartment of Cardiovascular Medicine Nippon Medical School 1‐1‐5, Sendagi, Bunkyo‐ku Tokyo 113‐0022 JapanDepartment of Cardiovascular Medicine Nippon Medical School 1‐1‐5, Sendagi, Bunkyo‐ku Tokyo 113‐0022 JapanDepartment of Cardiovascular Medicine Nippon Medical School 1‐1‐5, Sendagi, Bunkyo‐ku Tokyo 113‐0022 JapanDepartment of Cardiovascular Medicine Nippon Medical School 1‐1‐5, Sendagi, Bunkyo‐ku Tokyo 113‐0022 JapanDepartment of Cardiovascular Medicine Nippon Medical School Chiba Hokuso Hospital Chiba JapanDepartment of Cardiovascular Medicine Nippon Medical School Tama Nagayama Hospital Tokyo JapanDepartment of Cardiovascular Medicine Nippon Medical School Musashi Kosugi Hospital Tokyo JapanDepartment of Cardiovascular Medicine Shizuoka Medical Center Shizuoka JapanDepartment of Cardiovascular Medicine Nippon Medical School 1‐1‐5, Sendagi, Bunkyo‐ku Tokyo 113‐0022 JapanAbstract Aims Although the reno‐protective effects of sodium–glucose cotransporter 2 inhibitors are known in patients with heart failure or type 2 diabetes mellitus (T2DM), this effect has not been confirmed in patients with acute myocardial infarction (AMI). Methods and results The prospective, multicentre, randomized, double‐blind, placebo‐controlled EMBODY trial investigated patients with AMI and T2DM in Japan. The eligible patients included adults aged 20 years or older, diagnosed with AMI and T2DM, and who could be discharged within 2–12 weeks after the onset of AMI. One hundred and five patients were randomized (1:1) to receive once daily 10 mg empagliflozin or placebo within 2 weeks of AMI onset. In this sub‐analysis, we investigated the time course of renal functional parameters such as serum creatinine levels and estimated glomerular filtration rate (eGFR) from baseline to Weeks 4, 12, and 24. Ninety‐six patients (64 ± 11 years, 78 male) were included in the full analysis (n = 46 and 50 in the empagliflozin and placebo groups, respectively). We used serum creatinine and eGFR as indicators of renal function. In the placebo group, eGFR decreased from 66.14 mL/min/1.73 m2 at baseline to 62.77 mL/min/1.73 m2 by Week 24 (P = 0.023) but remained unchanged in the empagliflozin group (from 64.60 to 64.36 mL/min/1.73 m2, P = 0.843). In the latter group, uric acid improved from 5.8 mg/dL at baseline to 4.9 mg/dL at Week 24 (P < 0.001). In the earlier analysis of 56 patients with eGFR ≥ 60 mL/min/1.73 m2, the eGFR decreased and the serum creatinine increased from baseline to 24 weeks in the placebo group, significantly different to the empagliflozin group (−6.61 vs. +0.22 mL/min/1.73 m2, P = 0.008 and +0.063 vs. −0.001 mg/dL, P = 0.030, respectively). The changes in serum creatinine and eGFR from baseline to Week 24 were significantly correlated with those in uric acid in the placebo group (r = 0.664, P < 0.001 and r = −0.675, P < 0.001, respectively) but not in the empagliflozin group. Conclusions Empagliflozin prevented the kidney functional decline in patients with AMI and T2DM, especially those with baseline eGFR ≥ 60 mL/min/1.73 m2. Early administration of sodium–glucose cotransporter 2 inhibitors in these patients is considered desirable for renal protection.https://doi.org/10.1002/ehf2.13509Acute myocardial infarctionEmpagliflozinEstimated glomerular filtration rateSodium–glucose cotransporter 2 inhibitorType 2 diabetes mellitusUric acid |