Division of Cardiology, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil.
Brazilian Heart Study Group, State University of Campinas (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil.
Cardiovasc Diabetol. 2022 Aug 6;21(1):147. doi: 10.1186/s12933-022-01584-8.
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve endothelial dysfunction and reduce cardiovascular events in individuals with type 2 diabetes (T2D). Proprotein convertase subtilisin/kexin 9 (PCSK9i) inhibitors reduce cardiovascular events in high-risk patients. Whether the addition of PCSK9i to SGLT2i treatment adds benefits is not known.
To assess the PCSK9-i effect on the endothelial function of T2D individuals under treatment with SGLT2-i.
Individuals with T2D were randomized in a 1:1 ratio to a 16-week treatment with either empagliflozin (E) or empagliflozin plus evolocumab (EE). The primary endpoint was post-treatment change from baseline in flow-mediated dilation (FMD) at 1-min. Secondary outcomes included changes in plasma levels of nitric oxide metabolites and isoprostane.
A total of 110 patients were enrolled, the mean age was 58 years, and 71% were men. The median post-treatment change in FMD at 1-min was 2.7% (interquartile range [IQR]: 0.9%) and 0.4% (IQR: 0.9%) in the EE and E groups, respectively (p < 0.001). There was a greater increase in plasma levels of nitrate [5.9 (16.5) vs. 2.6 (11.8); p = 0.001] and nitrite [0.14 (0.72) vs. 0.02 (0.74); p = 0.025] in the EE group than in the E group, respectively. Isoprostane reduction was more pronounced in the EE group when compared to the E group [-1.7 (5.9) vs. -1.1 (5.3); p < 0.001).
In individuals with T2D, the addition of evolocumab on top of empagliflozin improves endothelial function.
钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）可改善 2 型糖尿病（T2D）患者的内皮功能障碍并降低心血管事件发生率。前蛋白转化酶枯草溶菌素 9（PCSK9i）抑制剂可降低高危患者的心血管事件发生率。但目前尚不清楚在 SGLT2i 治疗的基础上添加 PCSK9i 是否会带来额外获益。
评估 PCSK9i 对接受 SGLT2i 治疗的 T2D 患者内皮功能的影响。
将 T2D 患者按照 1:1 的比例随机分为 16 周的恩格列净（E）组或恩格列净联合依洛尤单抗（EE）组。主要终点为治疗 1 分钟后血流介导的舒张（FMD）较基线的变化。次要终点包括血浆一氧化氮代谢物和异前列烷水平的变化。
共纳入 110 例患者，平均年龄为 58 岁，71%为男性。治疗 1 分钟后 FMD 的中位变化值分别为 EE 组 2.7%（四分位距 [IQR]：0.9%）和 E 组 0.4%（IQR：0.9%）（p<0.001）。EE 组血浆硝酸盐水平升高更为明显[5.9（16.5）比 2.6（11.8）；p=0.001]，亚硝酸盐水平升高更为明显[0.14（0.72）比 0.02（0.74）；p=0.025]。与 E 组相比，EE 组的异前列烷降低更为明显[-1.7（5.9）比-1.1（5.3）；p<0.001]。
在 T2D 患者中，在恩格列净的基础上加用依洛尤单抗可改善内皮功能。
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