Journal of Cardiac Failure最新文献

Objective: Sotagliflozin, a dual sodium-glucose cotransporter 1 and 2 (SGLT1/2) inhibitor, improves kidney and heart failure (HF) outcomes through incompletely understood mechanisms. Soluble urokinase plasminogen activator receptor (suPAR), an immune-derived glycoprotein, is implicated in kidney and cardiovascular disease pathogenesis. We investigated.¹ whether sotagliflozin reduces suPAR levels.² whether baseline suPAR predicts cardiovascular outcomes, and.³ whether baseline suPAR modifies sotagliflozin's treatment effect.

Research design and methods: We measured suPAR levels at baseline and 1-year follow-up in a subset of patients from the SOLOIST-WHF trial, which evaluated sotagliflozin's effect on the composite outcome of cardiovascular death, HF hospitalization, and urgent HF visits in patients with type 2 diabetes and worsening HF. Cox proportional hazards modeling assessed associations between baseline suPAR and outcomes and tested for treatment-by-suPAR interaction. Analysis of covariance (ANCOVA) compared changes in suPAR between treatment groups.

Results: In the main SOLOIST-WHF trial, sotagliflozin reduced the primary composite outcome (HR 0.67, 95%CI 0.52-0.85). In this ancillary analysis (n=815 with available samples), the median baseline suPAR level was 4.7 ng/mL [IQR 3.7-6.1]. SuPAR levels decreased similarly in both treatment groups at 1-year: sotagliflozin (n=97, -6.2%, 95%CI [-12.0, -0.04]) vs. placebo (n=101, -7.9%, 95%CI [-13.5, -2.0]; p=0.69). Baseline suPAR was strongly associated with the primary outcome in a graded, dose-response manner, independent of treatment, systolic function, kidney function, and NT-proBNP: adjusted hazard ratio 2.21 (95%CI 1.36-3.60) for the fourth quartile (>6.06 ng/mL) vs. first quartile (≤3.67 ng/mL). The treatment effect of sotagliflozin was consistent across suPAR quartiles (P interaction=0.90).

Conclusions: The cardiovascular benefits of sotagliflozin are unlikely to be related to suPAR reduction, as sotagliflozin did not significantly alter suPAR levels and treatment efficacy was consistent across suPAR strata. However, suPAR remains a strong, independent predictor of HF outcomes. Further studies are needed to determine whether suPAR-targeted therapies can improve HF outcomes.

Background: Clinical practice guidelines recommend initiation of SGLT2 inhibitors when eGFR ≥20ml/min/1.73m². While continuing SGLT2 inhibitors when eGFR falls <20ml/min/1.73m² is recommended, data on the efficacy and safety of SGLT2i in this setting are limited.

Methods: In this post-hoc analysis of the CREDENCE trial, we used time-updated Cox proportional hazards models to assess the association between deterioration in eGFR to <20 ml/min/1.73m², efficacy and safety outcomes, and treatment with canagliflozin.

Results: Among 4,401 randomized participants, 443 (10.1%) experienced eGFR deterioration to <20 ml/min/1.73m² at least once in follow up. These participants experienced a higher risk of the primary composite outcome (HR 10.68; 95%CI: 8.50-13.41; P<0.001). Canagliflozin compared with placebo was associated with a lower risk of the primary outcome among participants who did (HR 0.87; 95%CI: 0.61-1.25) and did not (HR 0.69; 95%CI: 0.57-0.84) experience deterioration of eGFR to <20 ml/min/1.73m² (P_Interaction=0.18). While the incidence of adverse outcomes were higher among participants whose eGFR fell <20 ml/min/1.73m², event rates remained similar between treatment groups irrespective of eGFR decline <20 ml/min/1.73m².

Conclusions: In patients with type 2 diabetes and CKD whose eGFR fell <20ml/min/1.73m², continuation of canagliflozin was associated with persistent benefit for kidney and cardiovascular outcomes with no additional safety concerns. These data support current guideline recommendations to continue SGLT2 inhibitors until dialysis or transplantation.