THE PLACE OF SGLT2 INHIBITORS AND L-CARNITINE IN THE TREATMENT OF PATIENTS WITH STEMI ON THE BACKGROUND OF TYPE 2 DIABETES
DOI:
https://doi.org/10.11603/1811-2471.2023.v.i2.13903Keywords:
myocardial infarction, diabetes, insulin resistance, hyperglycemia, arginine, carnitine, dapagliflozinAbstract
SUMMARY. Insulin resistance (IR) plays a significant role in the development of cardiovascular diseases and has an adverse prognostic effect on the course of an acute myocardial infarction (AMI) due to a direct proatherogenic effect and a metabolically damaging effect on the contractile function of the myocardium.
The aim – to evaluate the effectiveness of treatment of patients with ACS (STEMI) in combination with T2DM by including the course of parenteral L-carnitine-carnivit and SGLT2 inhibitor dapagliflozin in the protocol therapy program.
Material and Methods. 85 patients with ACS (STEMI), which developed against the background of T2DM, were examined. The patients were divided into three groups: the 1st group consisted of 25 patients who received protocol drug treatment after PCV, the 2nd experimental group consisted of 28 people who additionally received carnivit (2.0 g) in the form of intravenous infusions, the 3rd group consisted of 32 people who dapagliflozin (10 mg/day) was additionally prescribed. The control group consisted of 20 practically healthy volunteers without cardiovascular pathology. The diagnosis of ACS (MI) was verified according to the recommendations of the ESC (2018), and T2DM - according to the ADAiIDF (2010). The presence of insulin resistance (IR) was assessed by the level of the HOMA-IR index.
Results. The majority of comorbid patients (ACS+T2DM) (87.5 %) had a complicated course of MI, which was caused by metabolic (energetic) changes in the myocardium and coronary vessels as a result of the additional effects of insulin resistance, hyperglycemia, and hyperinsulinemia. Violation of carbohydrate metabolism in these comorbid patients is evidenced by hyperglycemia and an increase in the NOMA index. Correction of detected hemodynamic disorders by using an arginine/carnitine mixture contributed to the reduction of post-infarction heart remodeling, an increase in PV (by 7 %) and a decrease in the frequency of life-threatening complications, and complex treatment with the additional inclusion of dapagliflozin significantly improved the disturbed hydrocarbon metabolism and reduced the level of IR.
Conclusions. Patients with myocardial infarction in combination with type 2 diabetes in the initial state develop pronounced insulin resistance with a violation of carbohydrate metabolism and a decrease in the systolic-diastolic function of the heart, which are triggers for the development of a complicated course of this comorbid pathology. Complex treatment with the inclusion of carnitine and dapagliflozin in these comorbid patients helped restore tissue sensitivity to insulin, improve carbohydrate metabolism, and significantly reduce the frequency of life-threatening complications.
References
Gandziuk, V.A., Dyachuk, D.D., & Kondratyuk, N.U. (2017). Dynamics of morbidity and mortality due to diseases of the circulatory system in Ukraine (regional aspect). Bulletin of Biology and Medicine, 2(136), 319-322. Retrieved from: http://nbuv.gov.ua/UJRN/Vpbm_2017_2_72.
Ivanyuk, А.V., & Orlova, N.M. (2020). Ischemic heart disease among the population of working age in Kyiv region: statistical analysis of the modern epidemiological situation. Reports of Vinnytsia National Medical University [Internet], 24(4), 694-699. DOI: 10.31393/reports-vnmedical-2020-24(4)-24. DOI: https://doi.org/10.31393/reports-vnmedical-2020-24(4)-24
Gach, O., Husseini, Z., & Lancellotti, P. (2018). Acute coronary syndrome. Rev. Med. Liege., 73(5-6), 243-250.
Stuart, R.M., Khan, O., Abeysuriya, R., Kryvchun, T., Lysak, V., Bredikhina, A., … Fraser-Hurt, N. (2020). Diabetes care cascade in Ukraine: an analysis of breakpoints and opportunities for improved diabetes outcomes. BMC Health Serv. Res., 20(1), 409. DOI: 10.1186/s12913-020-05261-y. PMID: 32393341; PMCID: PMC7212677. DOI: https://doi.org/10.1186/s12913-020-05261-y
WHO (2016). Diabetes fact sheet. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/diabetes.
Ormazabal, V., Nair, S., Elfeky, O., Aguayo, C., Salomon, C., & Zuñiga, F.A. (2018). Association between insulin resistance and the development of cardiovascular disease. Cardiovasc. Diabetol., 17(1), 122. DOI: 10.1186/s12933-018-0762-4. DOI: https://doi.org/10.1186/s12933-018-0762-4
Nolan, C.J., & Prentki, M. (2019). Insulin resistance and insulin hypersecretion in the metabolic syndrome and type 2 diabetes: Time for a conceptual framework shift. Diab. Vasc. Dis. Res., 16(2), 118-127. DOI: 10.1177/1479164119827611. DOI: https://doi.org/10.1177/1479164119827611
Freeman, A.M., & Pennings, N. (2022). Insulin Resistance. Treasure Island (FL): StatPearls Publishing.
Inzucchi, S.E., Khunti, K., Fitchett, D.H., Wanner, C., Mattheus, M., George, J.T., … Zinman, B. 2020Cardiovascular Benefit of Empagliflozin Across the Spectrum of Cardiovascular Risk Factor Control in the EMPA-REG OUTCOME Trial. J. Clin. Endocrinol. Metab., 105(9), 3025-3035. DOI: 10.1210/clinem/dgaa321. PMID: 32485734; PMCID: PMC7382052. DOI: https://doi.org/10.1210/clinem/dgaa321
Norhammar, A., Bodegård, J., Nyström, T., Thuresson, M., Nathanson, D., & Eriksson, J.W. (2019). Dapagliflozin and cardiovascular mortality and disease outcomes in a population with type 2 diabetes similar to that of the DECLARE-TIMI 58 trial: A nationwide observational study. Diabetes Obes. Metab., 21(5), 1136-1145. DOI: 10.1111/dom.13627. Epub 2019 Feb 6. PMID: 30609272; PMCID: PMC6593417. DOI: https://doi.org/10.1111/dom.13627
Berg, D.D., Jhund, P.S., & Docherty, K.F. (2021). Time to Clinical Benefit of Dapagliflozin and Significance of Prior Heart Failure Hospitalization in Patients With Heart Failure With Reduced Ejection Fraction. JAMA Cardiol., 6(5), 499-507. DOI: 10.1001/jamacardio.2020.7585. DOI: https://doi.org/10.1001/jamacardio.2020.7585
