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Publications

Journal Article Ppublish

PubMed: 42201656 DOI: 10.1097/HJH.0000000000004311

Effects of dapagliflozin and dulaglutide on blood pressure and coronary flow in liver steatosis patients with type 2 diabetes.

J Hypertens 44(7):1173-1184

Authors: Ignatios Ikonomidis, Eleni Michalopoulou, George Pavlidis, Panagiota Efstathia Nikolaou, Konstantinos Katogiannis, Vasiliki Prentza, John Thymis, Dimitrios Vlachomitros, Eleni Katsanaki, Gavriella Kostelli, Emmanouil Korakas, Loukia Pliouta, Aikaterini Kountouri, Dimitrios Kypraios, Dimitrios Dimitroulopoulos, Evangelos Oikonomou, Gerasimos Siasos, Ioannis S Papanikolaou, Vaia Lambadiari

Affiliations

  • 2nd Department of Cardiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens.
  • Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens.
  • 2nd Propaedeutic Department of Internal Medicine, Research Unit and Diabetes Center, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens.
  • Department of Gastroenterology, Saint Savvas Oncological Hospital.
  • 3rd Department of Cardiology, "Sotiria" Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens.
  • Hepatogastroenterology Unit, 2nd Propaedeutic Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.

Abstract

AIM

To investigate the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) on cardiovascular function and hepatic metabolism in patients with type 2 diabetes mellitus (T2DM) and metabolic-dysfunction associated steatotic liver disease (MASLD).

METHODS

This is an unblinded real-world study using propensity score analysis of consecutive patients with T2DM and MASLD received either SGLT-2i (dapagliflozin; n = 21), GLP-1RA (dulaglutide; n = 21), or dipeptidyl peptidase-4 inhibitors (DPP-4i; n = 20). At baseline and after 12 months, we assessed the perfused boundary region (PBR) as a marker of glycocalyx thickness, peripheral and central systolic blood pressure (cSBP), pulse wave velocity (PWV), coronary flow reserve (CFR), left ventricular global longitudinal strain (GLS), controlled attenuation parameter (CAP), and liver stiffness (E).

RESULTS

At 12 months, all patients had reduced glycosylated hemoglobin and body mass index compared to baseline (P < 0.001), as well as a significant reduction in cSBP, PBR, PWV, CAP, E, and increase in CFR and GLS (P < 0.01). The percentage decrease in peripheral and central SBP was related with the improvement in PBR, PWV, CFR, and GLS at 12 months (P < 0.01). Dulaglutide showed greater improvement in GLS (22.6% vs. 8.5%, vs. 5.9%, P = 0.015) and PBR (P = 0.037) than dapagliflozin and DDP-4i. Both dulaglutide and dapagliflozin showed a greater increase in CFR than DDP-4i post-treatment. The percentage reduction in CAP was associated with the decrease in PBR, PWV and with the increase in GLS (P < 0.05).

CONCLUSION

Twelve-month treatment with either SGLT-2i or GLP-1RA improves central hemodynamics, coronary flow and reduces hepatic steatosis in T2DM individuals with MASLD.

MeSH

Diabetes Mellitus, Hypertension, Blood, Glycocalyx, Blood Pressure, Liver, Therapeutics, Diabetes Mellitus, Type 2