根据基线血糖状态和体重指数，达格列净对急性心肌梗死后心脏代谢结局的影响：DAPA-MI试验的亚组分析。

Impact of Dapagliflozin on Cardiometabolic Outcomes After Acute Myocardial Infarction According to Baseline Glycemic Status and Body Mass Index: Subanalyses of the DAPA-MI Trial.

作者信息

Storey Robert F, Deanfield John, James Stefan, Ajjan Ramzi A, Eriksson Niclas, Erlinge David, de Belder Mark, Gale Chris P, Zaman Azfar, Hofmann Robin, Mellbin Linda, Andersen Kasper, Jiang Yunyun, Johansson Peter A, Ridderstråle Wilhelm, Langkilde Anna Maria, Parvaresh Rizi Ehsan, Oldgren Jonas, McGuire Darren K

机构信息

Division of Clinical Medicine University of Sheffield United Kingdom.

NIHR Sheffield Biomedical Research Centre Sheffield Teaching Hospitals NHS Foundation Trust Sheffield United Kingdom.

出版信息

J Am Heart Assoc. 2025 Aug 5;14(15):e040327. doi: 10.1161/JAHA.124.040327. Epub 2025 Jul 29.

DOI:10.1161/JAHA.124.040327

PMID:40728174

Abstract

BACKGROUND

Dapagliflozin improved cardiometabolic outcomes following myocardial infarction in patients without prior type-2 diabetes (T2DM) in the DAPA-MI (dapagliflozin in patients with myocardial infarction) trial. The effect of glycemic status and body mass index (BMI) post-myocardial infarction requires elucidation.

METHODS

Participants with T2DM diagnosis, without baseline hemoglobin A1c, or not receiving any study medication, were excluded. Eligible participants were categorized, according to baseline hemoglobin A1c, as normoglycemic (<5.7% [39 mmol/mol]) or prediabetes (5.7 to <6.5% [48 mmol/mol]) and according to baseline BMI (<25, 25 to <30, and ≥30 kg/m). Hazard ratios (HRs) with 95% CIs and 1-year Kaplan-Meier rates were determined for new-onset T2DM (investigator-reported or hemoglobin A1c ≥6.5%) and New York Heart Association symptom classification during follow-up.

RESULTS

Of 4017 DAPA-MI participants, 3425 were eligible. In 1926 with baseline normoglycemia, new-onset T2DM occurred in 0.6% and 1.6% assigned to dapagliflozin and placebo, respectively (hazard ratio, 0.40 [95% CI, 0.15-1.03]); in 1499 with prediabetes at baseline, new-onset T2DM occurred in 10.1% and 13.1%, respectively (hazard ratio, 0.74 [05% CI, 0.55-0.99]; interaction 0.23). One-year absolute risk reduction for new-onset T2DM was 8.1% in those with both prediabetes and BMI ≥30. Dapagliflozin reduced the occurrence of New York Heart Association class III-IV symptoms, with greater effect in those with prediabetes versus normoglycemia ( interaction 0.009). One-year absolute risk reduction for New York Heart Association class III-IV symptoms was 10.0% in those with both prediabetes and BMI ≥30.

CONCLUSIONS

Dapagliflozin reduced the occurrence of new-onset T2DM following myocardial infarction, regardless of baseline hemoglobin A1c or BMI. Dapagliflozin provided greater reduction in heart failure symptom burden in those with prediabetes compared with normoglycemia.

摘要

背景

在DAPA-MI（心肌梗死患者使用达格列净）试验中，达格列净改善了既往无2型糖尿病（T2DM）的心肌梗死患者的心脏代谢结局。心肌梗死后血糖状态和体重指数（BMI）的影响尚需阐明。

方法

排除诊断为T2DM、无基线糖化血红蛋白或未接受任何研究药物治疗的参与者。符合条件的参与者根据基线糖化血红蛋白分为血糖正常（<5.7%[39 mmol/mol]）或糖尿病前期（5.7%至<6.5%[48 mmol/mol]），并根据基线BMI（<25、25至<30以及≥30 kg/m²）进行分类。确定随访期间新发T2DM（研究者报告或糖化血红蛋白≥6.5%）和纽约心脏协会症状分类的风险比（HR）及95%置信区间（CI）和1年Kaplan-Meier发生率。

结果

在4017名DAPA-MI参与者中，3425名符合条件。在1926名基线血糖正常的参与者中，分别有0.6%和1.6%接受达格列净和安慰剂治疗的参与者发生新发T2DM（风险比，0.40[95%CI，0.15-1.03]）；在1499名基线糖尿病前期的参与者中，分别有10.1%和13.1%发生新发T2DM（风险比，0.74[95%CI，0.55-0.99]；交互作用P = 0.23）。在糖尿病前期且BMI≥30的参与者中，新发T2DM的1年绝对风险降低率为8.1%。达格列净降低了纽约心脏协会III-IV级症状的发生率，糖尿病前期患者的效果优于血糖正常患者（交互作用P = 0.009）。在糖尿病前期且BMI≥30的参与者中，纽约心脏协会III-IV级症状的1年绝对风险降低率为10.0%。