Effect of semaglutide on total myocardial ischemic burden and serum inflammatory factors in patients with type 2 diabetes mellitus complicated with coronary heart disease

doi:10.3969/j.issn.1004-583X.2022.11.006

Abstract

Abstract:

Objective To investigate the effects of semaglutide, a once-weekly glucagon-like peptide-1 receptor agonist (GLP-1RA), on total myocardial ischemic burden and inflammatory factors in patients with type 2 diabetes mellitus (T2DM) complicated with coronary heart disease (CHD). Methods From June 2021 to June 2022, totally 96 patients with T2DM and CHD admitted to the First Affiliated Hospital of Jinzhou Medical University were retrospectively recruited. They were randomized 1∶1 to the conventional treatment group and the semaglutide treatment group. Patients in the conventional treatment group were treated with standard hypoglycemic, hypotensive, lipid-regulating, and antiplatelet medications. According to blood glucose target, insulin glargine was applied and adjusted. Semaglutide injection 1.0 mg subcutaneously, once a week, was additionally given to those in the semaglutide treatment group. The clinical manifestations, body mass index (BMI), blood pressure, fasting blood glucose (FPG), blood lipids, glycosylated hemoglobin A₁c (HbA₁c) and other indicators were observed in the two groups before and 3 months after treatment, and the total myocardial ischemia burden and serum inflammation indicators were detected. Results One case was lost to follow-up in both groups. At the end of the trial, clinical symptoms, FPG, blood lipid and HbA₁c were significantly improved in the both groups. BMI and low-density lipoprotein cholesterol (LDL-C) in the semaglutide treatment group were significantly decreased than those in the conventional treatment group. The dosage of insulin glargine and incidence of hypoglycemia were significantly lower in the semaglutide treatment group than in the conventional treatment group. The total load of myocardial ischemia was significantly reduced in the both groups and the effect of semaglutide treatment group was better than that of the coventional treatment group. The serum levels of high sensitive C-reactive protein (hs-CRP) and interleukin-6 (IL-6) in the semaglutide treatment group were significantly decreased than those in the conventional treatment group. Conclusion Semaglutide provides clinical benefits to T2DM patients by lowering glucose, regulating lipid and reducing body weight. It delays the progression of coronary atherosclerosis in patients with T2DM and CHD, and improves myocardial ischemia and prognosis by inhibiting inflammatory response and reducing total myocardial ischemic load.

Key words: diabetes mellitus, type 2, coronary disease, semaglutide, total myocardial ischemic load, inflammatory cytokines

CLC Number:

R587.1

Wang Wenqi, Zhang Tao. Effect of semaglutide on total myocardial ischemic burden and serum inflammatory factors in patients with type 2 diabetes mellitus complicated with coronary heart disease[J]. Clinical Focus, 2022, 37(11): 996-1000.

Add to citation manager EndNote|Ris|BibTeX

URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2022.11.006

https://huicui.hebmu.edu.cn/EN/Y2022/V37/I11/996

Figures/Tables 4

组别	例数	性别[例(%)]		年龄 (岁)	糖尿病病程 (年)	BMI(kg/m²)		SBP(mmHg)		DBP(mmHg)
组别	例数	男	女	年龄 (岁)	糖尿病病程 (年)	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
常规治疗组	48	26(54.2)	22(45.8)	65.8±11.1	15(8,27)	26.4±1.9	26.8±1.8	133.6±12.8	132.9±10.6	78.8±8.8	78.4±7.8
司美格鲁肽治疗组	48	25(52.1)	23(47.9)	66.5±12.1	16(8,28)	26.6±1.8	24.8±1.9^*	133.7±11.3	130.9±11.2	78.4±9.2	77.8±9.7
统计值		χ²=0.036		$t$ =0.049	$t$ =3012	$t$ =0.524	$t$ =5.239	$t$ =0.040	$t$ =0.889	$t$ =0.323	$t$ =0.330
$P$ 值		>0.05		>0.05	>0.05	>0.05	<0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	性别[例(%)]		年龄 (岁)	糖尿病病程 (年)	BMI(kg/m²)		SBP(mmHg)		DBP(mmHg)
组别	例数	男	女	年龄 (岁)	糖尿病病程 (年)	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
常规治疗组	48	26(54.2)	22(45.8)	65.8±11.1	15(8,27)	26.4±1.9	26.8±1.8	133.6±12.8	132.9±10.6	78.8±8.8	78.4±7.8
司美格鲁肽治疗组	48	25(52.1)	23(47.9)	66.5±12.1	16(8,28)	26.6±1.8	24.8±1.9^*	133.7±11.3	130.9±11.2	78.4±9.2	77.8±9.7
统计值		χ²=0.036		$t$ =0.049	$t$ =3012	$t$ =0.524	$t$ =5.239	$t$ =0.040	$t$ =0.889	$t$ =0.323	$t$ =0.330
$P$ 值		>0.05		>0.05	>0.05	>0.05	<0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	FPG(mmol/L)				HbA₁c(%)			HDL-C(mmol/L)				LDL-C(mmol/L)
组别	例数	治疗前		治疗后		治疗前		治疗后	治疗前		治疗后		治疗前		治疗后
常规治疗组	47	7.89±0.56		6.42±0.47^*		7.32±0.81		6.85±0.77	1.43±0.13		1.43±0.12		3.66±0.21		3.04±0.21^*
司美格鲁肽治疗组	47	7.85±0.59		6.53±0.38^*		7.32±0.85		6.68±0.68^*	1.44±0.11		1.42±0.11		3.64±0.22		2.48±0.17^*
$t$ 值		0.337		1.248		0.000		1.135	0.403		0.421		0.451		14.209
$P$ 值		>0.05		>0.05		>0.05		>0.05	>0.05		>0.05		>0.05		<0.05
组别	例数	TG(mmol/L)			ACR(mg/g)				hs-CRP(mg/L)			IL-6(ng/L)
组别	例数	治疗前	治疗后		治疗前		治疗后		治疗前	治疗后		治疗前		治疗后
常规治疗组	47	1.44±0.11	1.41±0.12		98.21±5.52		96.65±6.79		9.03±0.74	6.31±0.50^*		98.32±6.86		76.65±5.12^*
司美格鲁肽治疗组	47	1.46±0.12	1.37±0.11^*		97.38±8.13		86.14±6.82^*		9.07±0.65	1.89±0.19^*		89.08±6.73		36.73±2.21^*
$t$ 值		0.842	1.685		0.579		7.486		0.278	56.651		0.542		49.076
$P$ 值		>0.05	>0.05		>0.05		<0.05		>0.05	<0.05		>0.05		<0.05

组别	例数	FPG(mmol/L)				HbA₁c(%)			HDL-C(mmol/L)				LDL-C(mmol/L)
组别	例数	治疗前		治疗后		治疗前		治疗后	治疗前		治疗后		治疗前		治疗后
常规治疗组	47	7.89±0.56		6.42±0.47^*		7.32±0.81		6.85±0.77	1.43±0.13		1.43±0.12		3.66±0.21		3.04±0.21^*
司美格鲁肽治疗组	47	7.85±0.59		6.53±0.38^*		7.32±0.85		6.68±0.68^*	1.44±0.11		1.42±0.11		3.64±0.22		2.48±0.17^*
$t$ 值		0.337		1.248		0.000		1.135	0.403		0.421		0.451		14.209
$P$ 值		>0.05		>0.05		>0.05		>0.05	>0.05		>0.05		>0.05		<0.05
组别	例数	TG(mmol/L)			ACR(mg/g)				hs-CRP(mg/L)			IL-6(ng/L)
组别	例数	治疗前	治疗后		治疗前		治疗后		治疗前	治疗后		治疗前		治疗后
常规治疗组	47	1.44±0.11	1.41±0.12		98.21±5.52		96.65±6.79		9.03±0.74	6.31±0.50^*		98.32±6.86		76.65±5.12^*
司美格鲁肽治疗组	47	1.46±0.12	1.37±0.11^*		97.38±8.13		86.14±6.82^*		9.07±0.65	1.89±0.19^*		89.08±6.73		36.73±2.21^*
$t$ 值		0.842	1.685		0.579		7.486		0.278	56.651		0.542		49.076
$P$ 值		>0.05	>0.05		>0.05		<0.05		>0.05	<0.05		>0.05		<0.05

组别	例数	甘精胰岛素注射液日剂量(IU)	低血糖[例(%)]
组别	例数	甘精胰岛素注射液日剂量(IU)	是		否
常规治疗组	47	28.9±5.6	15(31.9)		32(68.1)
司美格鲁肽治疗组	47	8.5±3.6	5(10.6)		42(89.4)
统计值		$t$ =41.952		χ²=12.289
$P$ 值		<0.05		<0.05

组别	例数	甘精胰岛素注射液日剂量(IU)	低血糖[例(%)]
组别	例数	甘精胰岛素注射液日剂量(IU)	是		否
常规治疗组	47	28.9±5.6	15(31.9)		32(68.1)
司美格鲁肽治疗组	47	8.5±3.6	5(10.6)		42(89.4)
统计值		$t$ =41.952		χ²=12.289
$P$ 值		<0.05		<0.05

组别	例数	心肌缺血总负荷(mm·min)
组别	例数	治疗前	治疗后
常规治疗组	47	418.61±12.99	286.11±12.43^*
司美格鲁肽治疗组	47	417.24±12.66	113.29±8.33^*
$t$ 值		0.569	63.261
$P$ 值		>0.05	<0.05

组别	例数	心肌缺血总负荷(mm·min)
组别	例数	治疗前	治疗后
常规治疗组	47	418.61±12.99	286.11±12.43^*
司美格鲁肽治疗组	47	417.24±12.66	113.29±8.33^*
$t$ 值		0.569	63.261
$P$ 值		>0.05	<0.05

References 20

[1]	Li Y, Teng D, Shi X, et al. Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: National cross sectional study[J]. BMJ, 2020, 369:m997.
[2]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华糖尿病杂志, 2021, 13(4):315-409.
[3]	Bragg F, Holmes MV, Iona A, et al. Association between diabetes and cause-specific mortality in rural and urban areas of China[J]. Jama, 2017, 317(3):280-289. doi: 10.1001/jama.2016.19720 pmid: 28114552
[4]	Rawshani A, Rawshani A, Franzén S, et al. Mortality and cardiovascular disease in type 1 and type 2 diabetes[J]. N Engl J Med, 2017, 376(15):1407-1418. doi: 10.1056/NEJMoa1608664 URL
[5]	Aronov D, Bubnova M, Ioseliani D, et al. The complex program of rehabilitation of patients with ischemic heart disease after coronary artery bypass surgery in ambulatory cardiorehabilitational department: Clinical effects of third stage of rehabilitation[J]. Kardiologiia, 2017, 57(3):10-19.
[6]	Jia G, Whaley-Connell A, Sowers JR. Diabetic cardiomyopathy: A hyperglycaemia-and insulin-resistance-induced heart disease[J]. Diabetologia, 2018, 61(1):21-28. doi: 10.1007/s00125-017-4390-4 URL
[7]	郭继鸿, 张萍. 动态心电图学[M]. 北京: 人民卫生出版社, 2003: 102.
[8]	Vladu IM, Forţofoiu M, Clenciu D, et al. Insulin resistance quantified by the value of HOMA-IR and cardiovascular risk in patients with type 2 diabetes[J]. Exp Ther Med, 2022, 23(1):73. doi: 10.3892/etm.2021.10996 pmid: 34934444
[9]	Kibel A, Selthofer-Relatic K, Drenjancevic I, et al. Coronary microvascular dysfunction in diabetes mellitus[J]. J Int Med Res, 2017, 45(6):1901-1929. doi: 10.1177/0300060516675504 pmid: 28643578
[10]	Taqueti VR, Di Carli MF. Coronary microvascular disease pathogenic mechanisms and therapeutic options: JACC state-of-the-art review[J]. J Am Coll Cardiol, 2018, 72(21):2625-2641. doi: 10.1016/j.jacc.2018.09.042 URL
[11]	刘爱国, 李国明, 高玉红, 等. 冠心病患者冠状动脉狭窄程度与心肌缺血总负荷的关系[J]. 山东医药, 2018, 58(22):48-50.
[12]	Reichert S, Schlitt A, Benten AC, et al. Data on IL-6 c.-174 G> C genotype and allele frequencies in patients with coronary heart disease in dependence of cardiovascular outcome[J]. Data Brief, 2016, 8:1295-1299. doi: 10.1016/j.dib.2016.07.020 pmid: 27570807
[13]	Anzai T. Inflammatory mechanisms of cardiovascular remodeling[J]. Circ J, 2018, 82(3):629-635. doi: 10.1253/circj.CJ-18-0063 pmid: 29415911
[14]	李军辉. 血清CRP、IL-6、糖化血红蛋白在2型糖尿病合并冠心病患者中的表达及意义[J]. 中国卫生工程学, 2021, 20(2):317-318.
[15]	Ahmann AJ, Capehorn M, Charpentier G, et al. Efficacy and safety of once-weekly semaglutide versus exenatide ER in subjects with type 2 diabetes (SUSTAIN 3): A 56-week, open-label, randomized clinical trial[J]. Diabetes Care, 2018, 41(2):258-266. doi: 10.2337/dc17-0417 pmid: 29246950
[16]	Rodbard HW, Lingvay I, Reed J, et al. Semaglutide added to basal insulin in type 2 diabetes (SUSTAIN 5): A randomized, controlled trial[J]. J Clin Endocrinol Metab, 2018, 103(6):2291-2301. doi: 10.1210/jc.2018-00070 pmid: 29688502
[17]	Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes[J]. N Engl J Med, 2016, 375(4):311-322. doi: 10.1056/NEJMoa1603827 URL
[18]	夏文静, 黄问银, 唐新虎, 等. 糖尿病心肌病治疗中GLP-1心血管系统保护效应的研究进展[J]. 医学综述, 2022, 28(9):1758-1762.
[19]	Madsbad S. Review of head-to-head comparisons of glucagon-like peptide-1 receptor agonists[J]. Diabetes Obes Metab, 2016, 18(4):317-332. doi: 10.1111/dom.12596 pmid: 26511102
[20]	覃群婷, 路文盛. 血糖波动对糖尿病大血管并发症发生机制的研究进展[J]. 山东医药, 2017, 57(25):110-112.