SGLT2 inhibitor and lipid metabolism in coronary artery disease with type 2 diabetes across glycemic control status

Aim: The lipid metabolic effect of sodium-dependent glucose transporter 2 inhibitor (SGLT2i) on the patients with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) remains unclear.

Methods: In this prospective cohort study, 550 patients with CAD and T2DM were included in the analysis. Participants were categorized into the SGLT2i group (n = 223) or the non-SGLT2i group (n = 327) according to the discharge prescription. The lipid metabolism markers include lipid profiles and atherogenic index of plasma (AIP) and triglyceride-glucose index (TyG). Associations between lipid metabolism markers and SGLT2i use were evaluated by multiple linear regression models across glycemic control status. Patients were stratified by glycemic control status based on baseline fasting blood glucose (FBG) levels.

Results: The mean age of enrolled patients was 59.1 ± 9.4 years, with 21.8% being female. After a median follow-up of 3.2 months, SGLT2i group showed greater reduction in triglyceride (-22.75% vs. -19.85%, P = 0.045), HbA1c (-8.45% vs. -1.25%, P < 0.001) and AIP (-0.12 vs. -0.07, P = 0.007) levels, and an increase in high-density lipoprotein cholesterol (3.9% vs. 2.6%, P = 0.002) levels than the non-SGLT2i group. Moreover, multiple linear regression analysis showed that SGLT2i use was associated with lower triglyceride (β = -0.089, 95% CI, -0.177 to -0.004, P = 0.039) and AIP (β = -0.052, 95% CI, -0.096 to -0.009, P = 0.018) levels. The greatest improvements in lipid metabolism markers was observed in patients with poorly controlled diabetes.

Conclusions: The use of SGLT2i was significantly associated with improvement of AIP and TG levels in patients with CAD and T2DM, and patients with poorly controlled diabetes might benefit more from SGLT2i treatment.