Optimization of treatment of stable coronary artery disease and concomitant type 2 diabetes mellitus using quercetin and empagliflozin
DOI:
https://doi.org/10.32782/2415-8127.2022.65.6Keywords:
coronary artery disease, diabetes mellitus, dyslipidemia, quercetin, empagliflozin.Abstract
The risk of developing cardiovascular complications is the same in people with diabetes mellitus and in patients with coronary artery disease. Diabetes mellitus is usually referred to as cardiovascular pathology and is considered as a pathogenetic link of the most common disorders of the human organism. Comprehensive correction of glycemia, hyperlipidemia and hypertension is the main target of therapy aimed at reducing the risk of progression of stable coronary artery disease (SCAD) in patients with type 2 diabetes mellitus. It remains relevant to study the possibility and feasibility of using drugs with multimodal action, which could effectively affect the many pathogenetic components of combined pathology. Study aim – to evaluate the effectiveness of drug therapy of stable coronary artery disease and concomitant type 2 diabetes mellitus using bioflavonoid quercetin and empagliflozin, considering the impact on modified risk factors and left ventricular remodeling processes. Methods. 96 patients were examined, all of them had SCAD FC II-III and type 2 diabetes mellitus. Depending on the treatment received, patients were divided into four groups: group I (n = 22) – patients who received basic therapy, group II (n = 26) – received quercetin with basic therapy, group III (n = 25) – took empagliflozin, and group IV (n = 23) – patients who received quercetin on the with basic therapy and empagliflozin. Duration of therapy was 12 weeks. Results. The use of quercetin probably helped to reduce angina pain, palpitations, shortness of breath, and empagliflozin helped to eliminate the manifestations of diabetic polyneuropathy, polydipsia and polyuria, and contributed to weight loss. In patients receiving empagliflozin, HbA1c reduction results in optimized carbohydrate metabolism. In addition, empagliflozin is likely to contribute to the normalization of high-density lipoproteins, and quercetin to both low and high-density lipoproteins. The use of empagliflozin has been shown to have a positive effect on intracardiac hemodynamics, which is contributed by the regression of left ventricular hypertrophy and the improvement of diastolic function. Conclusions. 1. The use of quercetin and empagliflozin in patients with coronary artery disease and concomitant type 2 diabetes mellitus contributed to a significant improvement in the general well-being of patients, the elimination of leading symptoms. 2. Patients with SCAD and concomitant type 2 diabetes mellitus have more profound changes in the lipid spectrum of the plasma, which is characterized by dyslipidemia being more atherogenic in nature. Studied therapy enhanced the antiatherogenic effect of statins, helped to reduce the level of total cholesterol and normalized the ratio of its fractions. 3. Additional administration of empagliflozin allowed to improve the components of transmitral diastolic flow: decreased IVRT, increased the E/A ratio. The improvement in LV diastolic function was accompanied by a decrease of LV mass index, a decrease in LV end diastolic diameter, an improvement in LV systolic function.
References
Haas A. V., McDonnell M.E. Pathogenesis of cardiovascular disease in diabetes. Endocrinology and Metabolism Clinics. 2018; 47(1): 51–63.
Unifikovanyi klinichnyi protokol pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) medychnoi dopomohy (UKPMD) “Stabilna ishemichna khvoroba sertsia”. Nakaz Ministerstva okhorony zdorovia Ukrainy vid 23.12.2021 № 2857. 2021. URL: https://www.dec.gov.ua/wp-content/uploads/2019/11/2016_152_ykpmd_ihs.pdf.
Cosentino F., Grant P.J., Aboyans V., Bailey C.J., Ceriello A., Delgado V., et al. 2019 ESC Guidelines on diabetes, prediabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD). European Heart Journal. 2020 Jan; 41(2): 255–323. URL: https://doi.org/10.1093/eurheartj/ehz486.
Unifikovanyi klinichnyi protokol pervynnoi vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) medychnoi dopomohy (UKPMD) “Tsukrovyi diabet II typu”. Nakaz MOZ Ukrainy № 1118 vid 21.12.2012 roku. 2012. URL: https://www. dec.gov.ua/wp-content/uploads/2019/11/2012_1118ykpmd.pdf.
WHO Consultation on Obesity. Obesity: preventing and managing the global epidemic: report of a WHO consultation. Geneva PP – Geneva: World Health Organization; 2000. (WHO technical report series ; 894). URL: https://apps.who.int/iris/ handle/10665/42330.
Pastor A., Conn J., MacIsaac R.J., Bonomo Y. Alcohol and illicit drug use in people with diabetes. The lancet Diabetes & endocrinology. 2020; 8(3): 239–48.
Litwak L.E., Elbert A., Faingold C., Grosembacher L.A., Proietti A., Puchulu F. Insulinoterapia en situaciones especiales. MEDICINA (Buenos Aires). 2017; 77(5): 410–421.
Roy P., Orecchioni M., Ley K. How the immune system shapes atherosclerosis: roles of innate and adaptive immunity. Nature Reviews Immunology. 2021; 1–15.
Nechyporuk N. Korvityn® – novi mozhlyvosti vidomoho preparatu kriz pryzmu doslidzhen. Zdorovia Ukrainy. 2019 Sep (cited 2022 May 24); 65(4): 37–37. URL: https://health-ua.com/multimedia/4/3/2/1/9/1569415673.pdf#page=37.
Zinman B., Wanner C., Lachin J.M., Fitchett D., Bluhmki E., Hantel S., et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. New England Journal of Medicine. 2015; 373(22): 2117–2128.
Fitchett D., Zinman B., Wanner C., Lachin J.M., Hantel S., Salsali A., et al. Heart failure outcomes with empagliflozin in patients with type 2 diabetes at high cardiovascular risk: results of the EMPA-REG OUTCOME® trial. Eur Heart J. 2016; 37(19): 1526–34.
Barnett A.H., Mithal A., Manassie J., Jones R., Rattunde H., Woerle H.J., et al. Efficacy and safety of empagliflozin added to existing antidiabetes treatment in patients with type 2 diabetes and chronic kidney disease: a randomised, double-blind, placebocontrolled trial. The lancet Diabetes & endocrinology. 2014; 2(5): 369–384.
Scheen A.J. Sodium-glucose cotransporter type 2 inhibitors for the treatment of type 2 diabetes mellitus. Nature reviews endocrinology. 2020; 16(10): 556–577.
Cowie M.R., Fisher M. SGLT2 inhibitors: mechanisms of cardiovascular benefit beyond glycaemic control. Nature Reviews Cardiology. 2020; 17(12): 761–72.
Anker S.D., Khan M.S., Shahid I., Filippatos G., Coats A.J.S, Butler J. Sodium-glucose co‐transporter 2 inhibitors in heart failure with preserved ejection fraction: reasons for optimism. Eur J Heart Fail. 2021; 23(8): 1250–1255.
Hiruma S., Shigiyama F., Hisatake S., Mizumura S., Shiraga N., Hori M., et al. A prospective randomized study comparing effects of empagliflozin to sitagliptin on cardiac fat accumulation, cardiac function, and cardiac metabolism in patients with early-stage type 2 diabetes: the ASSET study. Cardiovasc Diabetol. 2021; 20(1): 1–13.
Zhang Y.J., Han S.L., Sun X.F., Wang S.X., Wang H.Y., Liu X., et al. Efficacy and safety of empagliflozin for type 2 diabetes mellitus: meta-analysis of randomized controlled trials. Medicine. 2018; 97(43).
Lazoryshynets V.V., Kovalenko V.M., Potashev S.V., Fedkiv S.V., Rudenko A.V., Vitovskiy R.M., et al. Cardiac Chamber Quantification by Echocardiography in Adults: Recommendations from the Association of Cardiovascular Surgeons of Ukraine and Ukrainian Society of Cardiology. Ukrainian Journal of Cardiovascular Surgery. 2020 Dec; (4 (41) SE-RECOMMENDATIONS). URL: http://cvs.org.ua/index.php/ujcvs/article/view/391.
Zaremba V.S., Myskiv V.S., Chorniak N.I. Vplyv kompleksnoho likuvannia z vykorystanniam vodorozchynnoi formy kvertsetynu (korvitynu) na pokaznyky endotelialnoi funktsii ta lipidnoho spektru krovi u khvorykh na syndrom diabetychnoi stopy. Praktychna medytsyna. 2011; 17(3): 13–20.
M. Eid H., S. Haddad P. The antidiabetic potential of quercetin: underlying mechanisms. Curr Med Chem. 2017; 24(4): 355–364.
Mohos V., Pánovics A., Fliszár-Nyúl E., Schilli G., Hetényi C., Mladěnka P., et al. Inhibitory effects of quercetin and its human and microbial metabolites on xanthine oxidase enzyme. Int J Mol Sci. 2019; 20(11): 2681.
Mondal A., Maity T.K., Bishayee A. Analgesic and anti-inflammatory activities of quercetin-3-methoxy-4′-glucosyl-7- glucoside isolated from Indian medicinal plant Melothria heterophylla. Medicines. 2019; 6(2): 59.
Yakovleva T., Sokolov V., Chu L., Tang W., Greasley P.J., Peilot Sjögren H., et al. Comparison of the urinary glucose excretion contributions of SGLT2 and SGLT1: a quantitative systems pharmacology analysis in healthy individuals and patients with type 2 diabetes treated with SGLT2 inhibitors. Diabetes, Obesity and Metabolism. 2019; 21(12): 2684–2693.
Takahashi K., Nakamura A., Furusawa S., Yokozeki K., Sugawara H., Yanagisawa H., et al. Initial dip predicts renal protective effects after the administration of sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes and chronic kidney disease with normoalbuminuria. Journal of Clinical & Translational Endocrinology. 2020; 22: 100244.
