The use of GLP-1 analogues in the treatment of diabetes in patients with cardiovascular diseases. The expert opinion of the Working Group of Cardiovascular Pharmacotherapy of the Polish Cardiac Society

Wełnicki, Marcin; Gorczyca, Iwona; Mamcarz, Artur; Filipiak‬, Krzysztof J.; Wożakowska−Kapłon, Beata; Barylski, Marcin; Szymański, Filip M.; Kasprzak, Jarosław D.; Grabowski, Marcin; Dzida, Grzegorz

doi:10.33963/kp.a2022.0282

Cited by 6 publications

(4 citation statements)

References 64 publications

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“…In terms of T2DM therapy, the currently recommended sodium-glucose cotransporter inhibitors, or glucagon-like peptide-1 receptor antagonists, which may influence the risk of long term adverse events [ 42 ], were not used in the study group at the time of patient recruitment. Also, we did not assess patient compliance with the prescribed medications and glycemic control during follow-up.…”

Section: Discussionmentioning

confidence: 99%

Elevated plasma factor XI predicts cardiovascular events in patients with type 2 diabetes: a long-term observational study

Paszek

Polak

Bryk-Wiązania

et al. 2023

Cardiovasc Diabetol

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Background Type 2 diabetes mellitus (T2DM) patients are at high risk of cardiovascular (CV) events. Factor XI (FXI) is associated with arterial thromboembolism, including myocardial infarction (MI), stroke, and CV mortality. The role of FXI in T2DM is unknown. We investigated whether plasma FXI is associated with CV events in T2DM patients in long-term observation. Methods In 133 T2DM patients (aged 66 ± 8 years, 40.6% women, median T2DM duration 5 [2–10] years) we assessed plasma FXI levels, along with fibrin clot properties, thrombin generation, and fibrinolysis proteins. A composite endpoint of MI, stroke, or CV death, as well as CV mortality alone were assessed during a median follow-up of 72 months. Results Plasma FXI above the 120% upper normal limit was detected in 25 (18.8%) patients and showed positive association with LDL cholesterol and thrombin activatable fibrinolysis inhibitor, but not glycated hemoglobin, inflammatory markers or thrombin generation. The composite endpoint (n = 21, 15.8%) and CV death alone (n = 16, 12%) were more common in patients with elevated FXI (hazard ratio [HR] 10.94, 95% confidence interval [CI] 4.46–26.87, p < 0.001 and HR 7.11, 95% CI 2.61–19.31, p < 0.001, respectively). On multivariable analysis, FXI remained an independent predictor of the composite endpoint and CV death, regardless of concomitant coronary artery disease. Conclusions To our knowledge, this study is the first to show that in T2DM patients, elevated FXI could predict major CV events, including mortality, which suggest that anti-FXI agents might be a potential novel antithrombotic option in this disease.

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Section: Discussionmentioning

confidence: 99%

Elevated plasma factor XI predicts cardiovascular events in patients with type 2 diabetes: a long-term observational study

Paszek

Polak

Bryk-Wiązania

et al. 2023

Cardiovasc Diabetol

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“…The second option includes the use of microbiota metabolites with a protective role for the gut barrier, such as short-chain fatty acid (SCFA) including propionate, butyrate, and acetate, which can up-regulate epithelial adhesive protein [68]. Alternative approaches to improve gut permeability include probiotics, which are live bacteria, or prebiotics, which are plant-derived fibers, with a high intake of fish oils to increase the n-3/n-6 polyunsaturated fatty acids (PUFA) ratio, or drugs such as statins, or glucagon-like peptides that may have a beneficial effect on gut barrier dysfunction by modulating gut dysbiosis or up-regulating the intestinal adhesive proteins [69][70][71][72]. LPS detoxifyication is the third possibility to reduce the negative effects of endotoxemia.…”

Section: Therapeutic Perspectivesmentioning

confidence: 99%

Gut dysbiosis-derived low-grade endotoxemia: A common basis for liver and cardiovascular disease

et al. 2023

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Gut dysbiosis is characterized by bacteria overgrowth that ultimately leads to increased intestinal barrier permeability and translocation of bacteria or bacterial products such as lipopolysaccharide (LPS) in the portal and, eventually, systemic circulation. Intestinal epithelial cells and hepatocytes possess enzymatic armamentarium to counteract the LPS toxic effect, however, impaired degradation results in LPS accumulation in the hepatocytes and endothelial wall. Experimental and clinical studies documented that in patients with liver disease, such as nonalcoholic fatty acid liver disease (NAFLD), low-grade endotoxemia caused by LPS is implicated in liver inflammation and thrombosis via interaction with its Toll-like receptor 4 (TLR4) expressed by hepatocytes and platelets. Furthermore, studies in patients with severe atherosclerosis documented that LPS localizes in atherosclerotic plaque in close association with activated macrophages expressing TLR4 suggesting LPS's role in vascular inflammation, atherosclerotic progression, and thrombosis. Finally, LPS may directly interact with myocardial cells to induce electric and functional changes leading to atrial fibrillation or heart failure. This review will focus on experimental and clinical evidence suggesting that low-grade endotoxemia, as a mechanism, potentially accounts for vascular damage occurring at the level of the hepatic and systemic circulation and myocardial cells.

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“…Today, we attribute the abovementioned features to flozins (SGLT-2 inhibitors) [ 35 , 36 ]. The second extremely important group of drugs — glucagon-like peptide-1 (GLP-1) receptor agonists — seem to be even more beneficial than SGLT-2 inhibitors in two aspects: weight loss and stroke prevention [ 37 ]. Unfortunately, in some of our countries, the economic availability of SGLT-2 inhibitors and GLP-1 receptor agonists is low, as these drugs are not reimbursed at all or not in the first line of treatment, which means that antidiabetic therapy is still initiated with other oral drugs.…”

Section: Struggle Formentioning

confidence: 99%

STRUGGLE FOR. Italian-Polish-Spanish-Uzbek-Vietnamese Expert Forum Position Paper 2023 for better control of classical modifiable risk factors in clinical practice

Filipiak,

Barrios,

Ferri

et al. 2023

Cardiol J.

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The progress in pharmacotherapy that has been made in recent years, including the introduction of very effective and safe lipid-lowering and antihypertensive drugs, has not yet translated into the expected universal control of blood pressure, lipid disorders and diabetes. In the STRUGGLE FOR Italian-Polish-Spanish-Uzbek-Vietnamese Expert Forum Position Paper 2023, experts from five countries recounted several points about the paradigms of cardiological and cardiometabolic care for better control of classical modifiable risk factors in the year 2023. It is believed herein, that the need to intensify treatment, actively search for patients with cardiovascular risk factors, especially with arterial hypertension, hypercholesterolemia and diabetes, should go hand in hand with the implementation of the latest therapy, based on single pill combinations including proven, effective antihypertensive, lipid-lowering and antidiabetic molecules, many of which are listed in the present document. There is a need to use both new technological concepts, completely new drugs, as well as novel treatment concepts such as metabolic treatment in coronary artery disease, try to intensify the fight against smoking in every way, including the available range of drugs and procedures reducing the harm. This approach will provide substantially better control of the underlying cardiovascular risk factors in countries as varied as Italy, Poland, Spain, Uzbekistan and Vietnam.

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The use of GLP-1 analogues in the treatment of diabetes in patients with cardiovascular diseases. The expert opinion of the Working Group of Cardiovascular Pharmacotherapy of the Polish Cardiac Society

Cited by 6 publications

References 64 publications

Elevated plasma factor XI predicts cardiovascular events in patients with type 2 diabetes: a long-term observational study

Elevated plasma factor XI predicts cardiovascular events in patients with type 2 diabetes: a long-term observational study

Gut dysbiosis-derived low-grade endotoxemia: A common basis for liver and cardiovascular disease

STRUGGLE FOR. Italian-Polish-Spanish-Uzbek-Vietnamese Expert Forum Position Paper 2023 for better control of classical modifiable risk factors in clinical practice

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