Alterations in trimethylamine-N-oxide in response to Empagliflozin therapy: a secondary analysis of the EMMY trial

Cardiovascular Diabetology

Research

Andreas Meinitzer¹  Harald Mangge¹  Pero Curcic¹  Markus Hermann¹  Dirk von Lewinski²  Ewald Kolesnik²  Faisal Aziz³  Peter N. Pferschy³  Norbert J. Tripolt³  Harald Sourij³ 

[1] Clinical Institute for Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria;Division of Cardiology, Medical University of Graz, Graz, Austria;Interdisciplinary Metabolic Medicine Trials Unit, Graz, Austria;Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria;

关键词: Clinical trial;    RCT;    Empagliflozin;    Heart failure;    Myocardial infarction;    N;   

DOI  :  10.1186/s12933-023-01920-6

 received in 2023-05-15, accepted in 2023-07-11,  发布年份 2023

来源: Springer

【 摘 要 】

IntroductionThe relationship between sodium glucose co-transporter 2 inhibitors (SGLT2i) and trimethylamine N-oxide (TMAO) following acute myocardial infarction (AMI) is not yet explored.MethodsIn this secondary analysis of the EMMY trial (ClinicalTrials.gov registration: NCT03087773), changes in serum TMAO levels were investigated in response to 26-week Empagliflozin treatment following an AMI compared to the standard post-MI treatment. Additionally, the association of TMAO changes with clinical risk factors and cardiorenal biomarkers was assessed.ResultsThe mean age of patients (N = 367) was 57 ± 9 years, 82% were males, and 14% had type 2 diabetes. In the Empagliflozin group, the median TMAO value was 2.62 µmol/L (IQR: 1.81) at baseline, 3.74 µmol/L (2.81) at 6 weeks, and 4.20 µmol/L (3.14) at 26 weeks. In the placebo group, the median TMAO value was 2.90 µmol/L (2.17) at baseline, 3.23 µmol/L (1.90) at 6 weeks, and 3.35 µmol/L (2.50) at 26 weeks. The serum TMAO levels increased significantly from baseline to week 6 (coefficient: 0.233; 95% confidence interval 0.149–0.317, p < 0.001) and week 26 (0.320, 0.236–0.405, p < 0.001). The average increase in TMAO levels over time (pinteraction = 0.007) was significantly higher in the Empagliflozin compared to the Placebo group. Age was positively associated with TMAO, whereas eGFR and LVEF were negatively associated with TMAO.ConclusionsOur results are contrary to existing experimental studies that showed the positive impact of SGLT2i on TMAO precursors and cardiovascular events. Therefore, we recommend further research investigating the impact of SGLT2i therapy on acute and long-term changes in TMAO in cardiovascular cohorts.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 2