Dapagliflozin-induced integrated improvements in left ventricular diastole, endothelial function, and arterial load: a randomized clinical trial
Abstract
BACKGROUND: Dapagliflozin has been shown in preclinical and clinical settings to improve arterial function and left ventricular (LV) diastolic performance, yet the interrelationship between these effects has not been established.
OBJECTIVE: To determine whether improvements in endothelial function accompany-and relate to-early changes in LV diastolic function after short-term dapagliflozin in type 2 diabetes (T2D).
METHODS: We conducted a prespecified secondary analysis of a prospective, open-label, active-controlled trial of patients with T2D on background metformin that were randomized to daily dapagliflozin 10 mg or glibenclamide 5 mg for 12 weeks. All patients underwent echocardiographic and endothelial function assessments at baseline and 12 weeks. The primary endpoint for echocardiographic diastolic parameters was the change in E/e'. Endpoints for endothelial function were change in brachial artery flow-mediated dilation (FMD) and nitric oxide (NO) bioavailability. Arterial load comprises arterial impedance, measured as the brachial artery resistivity index, and the afterload components, the systemic vascular resistance and the ventriculo-arterial coupling index, as a marker of arterial stiffness.
RESULTS: Among 96 patients (mean age 59 years; 40% female; baseline HbA1c 7.8%; 75% at intermediate risk H2FPEF score), glycemic control improved similarly in both groups (median [IQR] HbA1c change: -0.78 [0.11]% vs. -0.80 [0.10]%; between-group p = 0.887). Dapagliflozin…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 96 participants or records.
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