Department of Cardiology, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey.
Eur Rev Med Pharmacol Sci. 2023 Aug;27(16):7620-7628. doi: 10.26355/eurrev_202308_33414.
Type 2 diabetes mellitus (T2DM) is known to be associated with endothelial dysfunction (ED). Reducing ED can attenuate the occurrence of cardiovascular diseases. One of the indicators of ED is decreased coronary blood flow (CBF). Sodium-glucose co-transporter 2 inhibitors (SGLT-2is) are known to directly improve ED in both euglycemic and hyperglycemic conditions and have been shown to decrease the incidence of major cardiovascular events. We aimed to investigate whether SGLT-2is improves CBF in patients with T2DM, who have angiographically normal or nearly normal coronary arteries.
In this single-center retrospective study, all patients who underwent coronary angiography between January 2017 and September 2022 were screened. We designed the study by dividing the patients into two groups - those who used conventional antidiabetic medications (CAM) together with SGLT-2is (patients using an SGLT-2 inhibitor for at least 3 months) and those who used only conventional antidiabetic medications. Of the 18,205 patients who underwent coronary angiography, 5,040 patients had T2DM. After exclusion, 288 patients were divided into two groups - those who used CAM together with SGLT-2is and those who used only CAM. CBF was assessed by thrombolysis in myocardial infarction (TIMI) frame counting.
Two hundred eighty-eight patients who had T2DM and met the inclusion criteria were included in our study. The patients were divided into two groups - those who used CAM together with SGLT-2is (n = 75) and those who used only CAM (n = 213). The median age in the group that used CAM together with SGLT-2is was 55 (51-64), where 52 (69.3%) patients were female. The mean TIMI frame count (TFC) was 23.5 in the group using CAM + SGLT-2is and 27.5 in the group using only CAM. In the multivariable linear regression analysis, the mean TFC was significantly lower in the group using CAM together with SGLT-2is compared to the group using only CAM [β-coefficient = -12.766, 95% Cl: -5.304; -3.887, p < 0.001]. Moreover, there was a statistically significant correlation between an increase in BMI and hemoglobin with an increase in the mean TFC [β-coefficient = 3.018, 95% Cl 0.037-0.175, p = 0.003 and β-coefficient = 2.316, 95% Cl 0.033-0.405, p = 0.021, respectively].
We have demonstrated that the use of SGLT-2is improves coronary artery blood flow in patients with T2DM who have normal or nearly normal coronary angiography.
2 型糖尿病（T2DM）已知与内皮功能障碍（ED）有关。降低 ED 可以减轻心血管疾病的发生。ED 的一个指标是冠状动脉血流（CBF）减少。钠-葡萄糖协同转运蛋白 2 抑制剂（SGLT-2is）已知在血糖正常和高血糖条件下均可直接改善 ED，并已显示可降低主要心血管事件的发生率。我们旨在研究 SGLT-2is 是否可以改善血管造影正常或几乎正常的冠状动脉的 T2DM 患者的 CBF。
在这项单中心回顾性研究中，筛选了 2017 年 1 月至 2022 年 9 月期间接受冠状动脉造影的所有患者。我们通过将患者分为两组来设计研究——一组使用常规降糖药物（CAM）加 SGLT-2is（至少使用 SGLT-2is 3 个月的患者），另一组仅使用常规降糖药物。在接受冠状动脉造影的 18205 名患者中，有 5040 名患有 T2DM。排除后，288 名患者被分为两组——一组使用 CAM 加 SGLT-2is，另一组仅使用 CAM。通过心肌梗死溶栓治疗（TIMI）帧数计数评估 CBF。
我们的研究纳入了 288 名患有 T2DM 且符合纳入标准的患者。患者被分为两组——一组使用 CAM 加 SGLT-2is（n=75），另一组仅使用 CAM（n=213）。使用 CAM 加 SGLT-2is 的组中位年龄为 55（51-64）岁，其中 52（69.3%）名患者为女性。使用 CAM+SGLT-2is 的组平均 TIMI 帧数（TFC）为 23.5，而仅使用 CAM 的组为 27.5。在多变量线性回归分析中，与仅使用 CAM 的组相比，使用 CAM 加 SGLT-2is 的组的平均 TFC 明显降低[β 系数=-12.766，95%Cl：-5.304；-3.887，p<0.001]。此外，BMI 和血红蛋白的增加与平均 TFC 的增加呈统计学显著相关[β 系数=3.018，95%Cl 0.037-0.175，p=0.003 和 β 系数=2.316，95%Cl 0.033-0.405，p=0.021]。
我们已经证明，在血管造影正常或几乎正常的 T2DM 患者中，使用 SGLT-2is 可改善冠状动脉血流。
