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VERTIS CV试验中根据基线体重指数得出的长期体重减轻及心肾结局

Long-term weight loss and cardiorenal outcomes by baseline BMI in the VERTIS CV trial.

作者信息

Cosentino Francesco, Dagogo-Jack Samuel, Frederich Robert, Cannon Christopher P, Cherney David Z I, Mancuso James P, Wynant Willy, Xing Aiwen, Gantz Ira, Cater Nilo B, Pratley Richard E

机构信息

Department of Medicine, Solna, Karolinska Institute, Unit of Cardiology, Stockholm, Sweden.

Heart, Vascular and Neuro Theme, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.

出版信息

Diabetes Obes Metab. 2025 Feb;27(2):583-594. doi: 10.1111/dom.16050. Epub 2024 Dec 18.

Abstract

AIM

To assess weight loss and cardiorenal outcomes by baseline body mass index (BMI) in VERTIS CV.

METHODS

Patients with type 2 diabetes and atherosclerotic cardiovascular (CV) disease were randomized to ertugliflozin or placebo. These post hoc analyses evaluated cardiometabolic and cardiorenal outcomes (a composite of death from CV causes or hospitalization for heart failure [HHF], CV death, HHF and an exploratory composite kidney outcome including ≥40% estimated glomerular filtration rate [eGFR] decrease) by baseline BMI, using conventional clinical categories and Cox proportional hazards models.

RESULTS

In total, 8246 adults were randomized (mean age 64.4 years, diabetes duration 13.0 years, BMI 32.0 kg/m, 61% with BMI >30 kg/m). Absolute body weight reduction was greater with ertugliflozin versus placebo at 3 and 5 years in the overall population (p < 0.001) and across BMI subgroups. Ertugliflozin increased the proportion of participants achieving ≥5% and ≥10% body weight reduction (ertugliflozin 34.9% and 13.6%, placebo 19.4% and 4.1%; odds ratio [95% confident interval, CI], 2.21 [1.76-2.77] and 3.65 [2.39-5.57], respectively) at 5 years. No significant difference was observed in the effect of ertugliflozin on HHF across BMI subgroups (P = 0.61). Similarly, no significant difference was observed in the effect of ertugliflozin on the kidney composite outcome across BMI subgroups (P = 0.39). Results were similar for other CV outcomes, and safety was consistent with the known ertugliflozin profile.

CONCLUSION

Weight loss was observed across baseline BMI and was sustained over 5 years of follow-up. The effects of ertugliflozin on HHF and kidney composite were consistent across baseline BMI.

摘要

目的

在VERTIS CV研究中,根据基线体重指数(BMI)评估体重减轻情况及心肾结局。

方法

将2型糖尿病和动脉粥样硬化性心血管(CV)疾病患者随机分为依鲁格列净组或安慰剂组。这些事后分析使用传统临床分类和Cox比例风险模型,根据基线BMI评估心脏代谢和心肾结局(CV病因导致的死亡或因心力衰竭住院治疗[HHF]、CV死亡、HHF以及一个探索性肾脏复合结局,包括估计肾小球滤过率[eGFR]下降≥40%)。

结果

总共8246名成年人被随机分组(平均年龄64.4岁,糖尿病病程13.0年,BMI为32.0kg/m²,61%的人BMI>30kg/m²)。在总体人群中以及各BMI亚组中,依鲁格列净组在3年和5年时的绝对体重减轻幅度均大于安慰剂组(p<0.001)。依鲁格列净增加了体重减轻≥5%和≥10%的参与者比例(5年时,依鲁格列净组分别为34.9%和13.6%,安慰剂组分别为19.4%和4.1%;优势比[95%置信区间,CI]分别为2.21[1.76 - 2.77]和3.65[2.39 - 5.57])。在各BMI亚组中,未观察到依鲁格列净对HHF的影响有显著差异(P = 0.61)。同样,在各BMI亚组中,未观察到依鲁格列净对肾脏复合结局的影响有显著差异(P = 0.39)。其他CV结局的结果相似,安全性与已知的依鲁格列净情况一致。

结论

在整个基线BMI范围内均观察到体重减轻,且在5年随访期内持续存在。依鲁格列净对HHF和肾脏复合结局的影响在整个基线BMI范围内是一致的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7074/11701189/79b3fca36efb/DOM-27-583-g001.jpg

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