Comparative evaluation new glucagon-like peptide 1 receptor agonist semaglutide and sodium-glucose cotransporter-2 inhibitors empagliflozin on left ventricular diastolic function in patients with arterial hypertension, obesity and type 2 diabetes mellitus

The aim of this study is conducting a comparative analysis of the effect of 24 weeks of therapy of glucagon-like peptide-1 receptor agonists (aGLP-1) semaglutide and a sodium-glucose co-transporter 2 inhibitors (SGLT2) empaglifosin on the left heart chambers and the severity of epicardial adipose tissue (EAT) in patient with arterial hypertension (АН), obesity and diabetes mellitus (DM).

Materials and methods: 91 patients (40.7% women and 59.3% men) aged 44-65 years with type 2 DM (glycated hemoglobin level over 6.5%) and obesity (WC over 80 cm in women and over 94 cm in men) were successively included in the study. All patients received standard antihypertensive and hypolipidemic therapy, in addition, all patients were on metformin monotherapy at a dose of 1000-2000 mg/day (during the follow-up, the therapy did not change). Anthropometric measurements, echocardiography were carried out to evaluate the structural and functional parameters of LV using transmitral and tissue Doppler and determine the thickness of EAT. After a preliminary examination, all patients were randomized on two groups: the 1st group was prescribed semaglutide therapy with an initial dose of 0.25 mg and gradual titration every 4 weeks to 1.0 mg, the 2nd group was prescribed empagliflozin at a dose of 10 or 25 mg. After 24 weeks, all patients were re-examined.

Results: semaglutide and empagliflozin improved a structural and functional condition of the left heart chambers — LV mass, LV mass index (LVMI), the LA index volume, practically all of indicators of the LV diastolic function (E/A ratio, LV-filling pressure, Еmlat , Emsept velosity) in patients with AH, obesity and DM 2 types. In addition, in the semaglutide group, a pronounced decrease in the EAT thickness with 0.76 cm [0.56; 0.8] to 0.71 cm [0.5; 0.74] (p < 0.001), which was not observed in the empagliflozin group. Apparently, semaglutide and empagliflozin positive effect on the left heart chambers achieved by the different mechanisms. In the 1st group by means of decrease LVMI and EAT thickness, in the 2nd group through reduction heart preload and LV-filling pressure according improve LV relaxation.

Conclusion: the new sugar-lowering agents should be prescribed to patients with type 2 DM and CVD or a high risk of CVD development taking into account their impact on the cardiovascular prognosis, and in some cases considering the need for a combination of these drugs.

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