2) Part 1 has been primarily authored by @GoggleDocs co-cofounder @drpatrickholmes and new @GoggleDocs #pharmacist @Ines_VFonseca. We are thrilled to have them commandeer our network and bring to our global learners SO MUCH exciting data from #ADA2022! pic.twitter.com/mHuTS5zqDI
— @CKD_ce (@ckd_ce) August 16, 2022
4) Faculty disclosures and statement of accreditation are provided at https://t.co/PHlIppl6Yw. Please FOLLOW @ckd_ce and @cardiomet_ce so you don’t miss any of our unique #accredited #serialized #tweetorials, always 🆓, always from expert authors!
— @CKD_ce (@ckd_ce) August 16, 2022
6) This program focuses on data from #ADA2022 on #SGLT2 inhibitors in the management of cardiac disease, starting with heart failure. After all, none other than #MiltonPacker said: pic.twitter.com/kVCfSn65qs
— @CKD_ce (@ckd_ce) August 16, 2022
8a) So let’s level-set here. What is your current
— @CKD_ce (@ckd_ce) August 16, 2022
practice when managing #HFrEF?
a. ACEi/ARB → BB → MRA → SGLT2i
b. SGLT2i + BB → ACEi/ARNi → MRA
9) Our friend & #SoMe education advocate @SantosGallegoMD holds: #SGLT2 inhibitors are efficacious for #heartfailure independently of #LVEF
— @CKD_ce (@ckd_ce) August 16, 2022
See 🔓https://t.co/Ozokk6bzeC
11) In the #EMPATROPISM trial that @SantosGallegoMD led, the effects of #empagliflozin on LVF and volumes, functional capacity, & #QoL were evaluated in non-#T2DM #HFrEF patients. Primary pub was 🔓https://t.co/XC37J6tEvG pic.twitter.com/3CC9CFSbgK
— @CKD_ce (@ckd_ce) August 16, 2022
13) Conclusions:
— @CKD_ce (@ckd_ce) August 16, 2022
👉#Empagliflozin improves cardiac remodelling by improving LV volumes, LV mass, LV systolic function, functional capacity, & QOL vs placebo
👉Corroborates benefits of SGLT2i class in the treatment of #HFrEF patients independent of their diabetes status
15) These data show
— @CKD_ce (@ckd_ce) August 16, 2022
↓ diastolic dysfunction (ECHO and cardiac MRI data)
↓ myocardial fibrosis
↓ oxidative stress
↓ cardiomyocyte stiffness
indicating that #empagliflozin ameliorates #diastolic_dysfunction and LV fibrosis/stiffness in non-diabetes HF
16b) It is a mechanistic Cardiac Magnetic Resonance (#CMR) study of 72 pts with #HFrEF or #HFpEF, with or without #T2D. Results anticipated late 2022-early 2023. These results may prove pivotal to shift paradigms into managing #LVEF as a disease continuum! pic.twitter.com/Qp34NZ4UUa
— @CKD_ce (@ckd_ce) August 16, 2022
18) How’d you do? It’s B, because #SGLTi‘s are thought actually to ↓ LV volume in non-T2DM HFrEF patients. Choices A, C, and D also are part of the presumed SGLT2i mechanism of action. pic.twitter.com/wlBi2hKJ8p
— @CKD_ce (@ckd_ce) August 16, 2022
20) The “#ketone hypothesis” is a theory of cardiac metabolism & shift in fuel energetics. We posit that here because the inhibition of SGLT2 reduces plasma glucose levels, thereby promoting lipolysis in adipose tissue, which in turn enhances the generation of ketone bodies. pic.twitter.com/r3KkxdnKNs
— @CKD_ce (@ckd_ce) August 16, 2022
22a) 🔑points:
— @CKD_ce (@ckd_ce) August 16, 2022
🫀 24 participants with #T2D & #HFrEF
🫀 On established Metformin ± SU
🫀Randomised to low dose (I) or high dose (II) of #BOHB infusions
🫀 Cardiac MRI before and after each infusion
22c) The authors concluded that in pts w/ #T2D + #HFrEF, ⬆️plasma ketones significantly ⬆️ LV function & may be dose-dependent. This supports the hypothesis that plasma ketones can provide an additional fuel for the 🫀 . . .
— @CKD_ce (@ckd_ce) August 16, 2022
23) What does the future hold in this area?
— @CKD_ce (@ckd_ce) August 16, 2022
👉Imaging to examine #BOHB uptake in the myocardium
👉Evaluate effects in non-#T2D cohort
👉Studies with #ketogenic/low carb diets pic.twitter.com/ksSJtg4Fgt
25) There are potential mechanisms by which #SGLT2i may ⬇️AFib:
— @CKD_ce (@ckd_ce) August 16, 2022
👉↑ Diuresis/natriuresis → ↓ atrial dilation
👉↓ Mitochondrial dysfunction & atrial remodelling
🫀 ↓ AF risk factors: ↓ BP, weight, inflammation & oxidative stress
27a) The aim of the study was to assess the association between initiation of #SGLT2i vs comparator & incident AF in older adults with T2DM. 🔑points:
— @CKD_ce (@ckd_ce) August 16, 2022
📍Population-based cohort study of 🇺🇸 nationwide database, >300K pts w/ T2D
📍>65 years old
(cont)
27c) The study excluded:
— @CKD_ce (@ckd_ce) August 16, 2022
👉T1D or secondary DM
👉malignancy
👉#ESKD
👉organ transplant
👉prior #AF
28a) Results: Over a median follow-up ~6 months, risk of AF 🏥 was lower in the #SGLT-2i group than the #DPP4i group (HR, 0.82) or the #GLP1RA group (0.90) . Findings for secondary outcomes were consistent with the primary outcome.
— @CKD_ce (@ckd_ce) August 16, 2022
29) Now let’s look at data from #ADA22 on #SGLT2i across the spectrum of #CV risk. Check out the EMPagliflozin compaRative effectIveness and SafEty (#EMPRISE) study 🔓https://t.co/pP4vyZiDCx which considered #CV effectiveness of 30vs. #GLP1RAs or #Liraglutide pic.twitter.com/4ACrOFAqGP
— @CKD_ce (@ckd_ce) August 16, 2022
30c) Do you remember #CVOT #EMPA_REG_OUTCOME? What are the advantages/disadvantages of #EMPRISE over #EMPA_REG?
— @CKD_ce (@ckd_ce) August 16, 2022
Answer before you move on!
a. Larger scale study
b. Comparators more relevant than placebo
c. Risk of residual bias
d. All the above
32) In fact, EMPRISE & EMPA-REG OUTCOME are complementary studies which support the use of #SGLT2i’s in those with #T2D regardless the baseline history of #CVD.
— @CKD_ce (@ckd_ce) August 16, 2022
34) So now you need to do 2⃣ things:
— @CKD_ce (@ckd_ce) August 16, 2022
1⃣ Go to https://t.co/ydH9cqgBrN and claim your 🆓CE/#CME: #physicians #nurses #pharmacists!
2⃣ Follow us so that YOU DON’T MISS next week’s Part 2 of our highlights of the #DKD program at #ADA2022. pic.twitter.com/P4O2sI8RRJ
35) For now, we are @Ines_VFonseca and @drpatrickholmes from @GoggleDocs signing off.
— @CKD_ce (@ckd_ce) August 16, 2022
Shout-outs to @parthaskar @HannahBeba @kamleshkhunti @AliRacaniere @sotonDSN @WilmotEmma @ShivaniM_KC @Amandaepps123 @docwas @singhak_endo @mvaduganathan @RpratleyMD @AliceYYCheng @_diabetes101