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Effects of SGLT2 Inhibitors on Cardiac Mechanics in Hispanic and Black Diabetic Patients
Errol Moras1, Rishi Shrivastav2, Kruti D Gandhi1
1Department of Medicine, Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY 10025, USA.
Insights
Sodium-glucose cotransporter-2 (SGLT2) inhibitors improved cardiovascular outcomes in non-White diabetic patients, showing significant left ventricular remodeling and strain improvements. These benefits were partly driven by better glycemic control, suggesting potential population-specific therapeutic actions.
Area of Science:
- Cardiology
- Endocrinology
- Pharmacology
Background:
- Cardiovascular outcome trials for SGLT2 inhibitors often lack diverse representation, particularly from Black and Hispanic populations.
- Potential ethnicity- or gender-based differences in receptor physiology may influence SGLT2 inhibitor efficacy.
- Mechanisms of action, especially concerning diverse populations, require further investigation.
Purpose of the Study:
- To evaluate the impact of SGLT2 inhibitors on left ventricular (LV) remodeling and function in a cohort of diabetic patients, with a focus on underrepresented ethnic groups.
- To assess changes in LV global longitudinal strain (LV GLS), LV mass (LVM), and LV mass index (LVMI) following SGLT2 inhibitor initiation.
- To explore the association between glycemic control and changes in LV GLS.
Main Methods:
- Retrospective analysis of medical records for diabetic patients initiated on SGLT2 inhibitors (2013-2020).
- Exclusion of patients with pre-existing coronary artery disease, cardiac arrhythmias, or heart failure.
- Analysis of transthoracic echocardiographic (TTE) studies pre- and post-SGLT2 inhibitor initiation, including LV GLS, LVM, and LVMI, and diastolic function (MV E/E').
Main Results:
- Among 94 patients (68% Hispanic, 22.3% Black), significant improvements were observed in mean LV GLS (-15.3 to -16.5; p=0.01), LVM (198.4g to 187.05g; p=0.04), and LVMI (100.6g/m² to 94.3g/m²; p=0.03).
- No significant change was noted in the ratio of peak early diastolic mitral flow velocity to early diastolic mitral annular velocity (MV E/E'; p=0.38).
- Improvements in HbA1c (r²=0.82; p=0.026), LVM (r²=0.20; p=0.04), and LVMI (r²=0.20; p=0.04) were independently associated with changes in LV GLS.
Conclusions:
- SGLT2 inhibitors, alongside other cardioprotective medications, significantly improve LV remodeling and LV GLS in non-White diabetic patients.
- Improved glycemic control is a key factor driving these observed cardiovascular benefits.
- Further large-scale prospective studies are warranted to elucidate population-specific therapeutic effects of SGLT2 inhibitors.
Abstract:
Background: Clinical trials demonstrating improved cardiovascular outcomes with SGLT2 inhibitors have often had limited representation from Black and Hispanic populations. While the mechanisms of action are not well known, ethnicity- or gender-based receptor physiology may render SGLT2 inhibitors a better agent in certain populations over others. Methods: A medical records query yielded diabetic patients initiated on SGLT2 inhibitors between 2013 and 2020. Patients with coronary artery disease, cardiac arrhythmias, and heart failure were excluded. Transthoracic echocardiographic studies (TTE) before and after starting SGLT2 inhibitors were analyzed, and post-processing left ventricular global longitudinal strain (LV GLS) analysis was also performed on each echocardiographic study. Univariate outliers and patients with missing data were excluded. Results: Among 94 patients with TTE (mean age 60.7 years; 68% Hispanics, 22.3% Blacks; median follow up of 7 months), there were significant improvements in the mean LV GLS (-15.3 vs. -16.5; p = 0.01), LV mass (LVM) (198.4 ± 59.6 g vs. 187.05 ± 50.6 g; p = 0.04), and LV mass index (LVMI) (100.6 ± 26.6 g/m2 vs. 94.3 ± 25.4 g/m2; p = 0.03) before and after initiating SGLT2 inhibitors but no significant change in the ratio (MV E/E') of peak early diastolic mitral flow velocity (E) and spectral pulsed-wave Doppler-derived early diastolic velocity from the septal mitral annulus (E') (12.5 ± 5.7 vs. 12.7 ± 4.8; p = 0.38). Changes in HbA1c (r2 = 0.82; p = 0.026), LVM (r2 = 0.20; p = 0.04), and LVMI (r2 = 0.20; p = 0.04) were found to be independently associated with changes in values of LV GLS on follow-up echocardiograms, when compared to the pre-medication LV GLS number. Conclusion: Non-White diabetic patients receiving SGLT2 inhibitors against a backdrop of other cardioprotective medications demonstrate significant improvements in LV remodeling and LV GLS, driven in part by an improvement in glycemic control. Large, prospective studies are needed to explore the differences in the therapeutic actions of SGLT2 inhibitors among different populations.
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