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TOPLINE:

Dapagliflozin, an SGLT2 inhibitor, reduced the incidence of new-onset type 2 diabetes (T2D) following myocardial infarction (MI), regardless of baseline BMI or A1c levels, with a substantial reduction in heart failure symptoms seen in those with prediabetes and obesity.

METHODOLOGY:

• Researchers performed a subanalysis of the DAPA-MI trial to assess whether cardiometabolic benefits of dapagliflozin after MI varied by baseline glycaemic status or BMI.
• They included patients who experienced acute MI within the last 7-10 days with impaired left ventricular systolic function and had no prior history of T2D or chronic heart failure.
• Patients were randomly assigned to receive either dapagliflozin (n = 1725; mean age, 62.9 years; 19% women) or placebo (n = 1700; mean age, 62.8 years; 20% women).
• In this subanalysis, patients were categorised as those having normal glycaemic levels (A1c levels < 5.7%) or having prediabetes (A1c levels, 5.7% to < 6.5%); BMI categories were < 25, 25 to < 30, and ≥ 30.
• Key outcomes included new-onset T2D and the occurrence of heart failure symptoms classified on the basis of the New York Heart Association (NYHA) class, assessed over a median follow-up duration of 11.6 months.

TAKEAWAY:

• Patients who received dapagliflozin had a lower risk for new-onset T2D, irrespective of their baseline glycaemic status or BMI, than those who received placebo.
• Patients on dapagliflozin vs placebo showed a reduction in NYHA class III-IV symptoms, with a more pronounced effect seen in those with prediabetes than in those with normal A1c levels (P interaction =  .009).
• Patients with both prediabetes and BMI ≥ 30 showed a 71% reduction in the occurrence of NYHA class III-IV symptoms with dapagliflozin (P = .005), corresponding to a 1-year absolute risk reduction of 10%.
• Dapagliflozin was similarly effective in achieving 5% or more weight loss across all A1c levels and BMI categories; rates of cardiovascular events were comparable between dapagliflozin and placebo groups.

IN PRACTICE:

"The findings of the present subanalyses support having a low threshold for commencing SGLT2 inhibition following acute MI in those with evidence of dysglycemia and/or obesity," the researchers wrote.

SOURCE:

This study was led by Robert F. Storey, MD, DM, University of Sheffield, Sheffield, England. It was published online on July 29, 2025, in the Journal of the American Heart Association.

LIMITATIONS:

The definition of the subgroups in a post hoc manner may have introduced bias. All assessments were performed only during active treatment; thus, glycometabolic effects after stopping medication remained uncertain. The follow-up period was relatively short, event rates were low, and CIs for hazard ratios were wide.

DISCLOSURES:

The DAPA-MI trial received funding from AstraZeneca. Several authors reported receiving research grants, personal fees, and consulting honoraria and having other financial ties with various institutes and pharmaceutical and healthcare companies including AstraZeneca.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.