Short term effects of sodium-glucose cotransporter 2 inhibitors on lipid regulation in coronary artery disease patients undergoing Percutaneous Coronary Intervention: A Propensity-Matched Analysis

Abstract

Background Sodium-glucose cotransporter 2 (SGLT2) inhibitors are currently widely used hypoglycemic drugs. Due to its cardiorenal protective effect independent of hypoglycemic effect, it is turning out to be progressively significant in the cardiovascular field. However, the effect of SGLT2 inhibitors on lipids is still controversial. We aimed to investigate whether the use of SGLT2 inhibitors could further down-regulate LDL-cholesterol (LDL-C) level of patients undergoing percutaneous coronary intervention (PCI) with background hypolipidemic therapy. Methods The longitudinal data were collected from Hospital Information System (HIS) of the Sir Run Run Shaw Hospital. SGLT2 inhibitor users and nonusers undergoing PCI were selected. Lipid data at baseline and 1-month follow-up after PCI were recorded. Propensity score 1:1 matching (PSM), inverse probability of treatment weighting (IPTW), and overlap weighting (OW) were performed to adjust baseline demographic and clinical characteristics. Results We identified 2451 coronary artery disease patients undergoing percutaneous coronary intervention. On the one month follow up after PCI, the serum lipid profile of all patients showed that triglyceride (TG) (1.26 [0.94;1.75] vs 1.47 [1.06;2.06], P < 0.001), total cholesterol (TC) (3.32 [2.83;3.90] vs 4.20 [3.51;5.13], P < 0.001), LDL-cholesterol (LDL-C) (1.69 [1.27;2.13] vs 2.43 [1.81;3.12], P < 0.001), and VLDL-cholesterol (VLDL-C) (0.34 [0.14;0.57] vs 0.46 [0.22;0.74], P < 0.001) decreased significantly; Free fatty acids (FFA) (0.48 [0.33;0.61] vs 0.45 [0.28;0.56], P < 0.001) increased; HDL-cholesterol (HDL-C) and lipoprotein(a) (Lpa) have no significant difference (P > 0.05). There was no significant difference in the changes of seven indexes of serum lipid profile in PSM cohort, including 361 SGLT2 inhibitor users and 361 nonusers (P > 0.05). Similar trends were observed in IPTW and OW cohorts (P > 0.05). Conclusions In coronary artery disease patients undergoing percutaneous coronary intervention, SGLT2 inhibitors do not confer benefit or harm on lipid regulation in the context of the original hypolipidemic strategy.