The effect of sodium-glucose cotransporter-2 inhibitors on cardiovascular biomarkers and left ventricular function in patients with type 2 diabetes and concomitant cardiovascular disease

Abstract

Introduction: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated cardiovascular benefits in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to assess the effects of SGLT2i therapy on heart failure (HF)-related biomarkers — galectin-3 (GAL-3) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) — as well as on echocardiographic parameters of cardiac function in patients with T2DM and established cardiovascular disease (CVD). Material and methods: This prospective study included 61 patients with T2DM, all naïve to SGLT2i and with documented CVD. Patients were initiated on dapagliflozin or empagliflozin and followed for a minimum of 6 months (mean follow-up: 9 months). Baseline and post-treatment levels of GAL-3 and NT-proBNP were measured. Echocardiographic evaluation included left ventricular ejection fraction (LVEF) and diastolic function parameters. Results: Following treatment, a significant reduction in NT-proBNP concentrations was observed (p = 0.002), along with reductions in GAL-3 levels, body weight, and body mass index (BMI). LVEF significantly improved, with concomitant reductions in interventricular septum (IVS) and posterior wall thickness. NT-proBNP concentrations were higher in patients with atrial fibrillation, whereas GAL-3 levels were lower in those with BMI ≥ 30 kg/m². A significant inverse correlation between estimated glomerular filtration rate (eGFR) and NT-proBNP was noted. No major adverse cardiovascular events occurred, and no patient required intensification of HF therapy. Two patients discontinued treatment due to urogenital tract infections. Conclusions: In patients with T2DM and established CVD, SGLT2i therapy was associated with significant improvements in left ventricular function and reductions in HF-related biomarkers, supporting the cardioprotective and nephroprotective effects of this drug class.