Dapagliflozin Delivers Post-MI, Regardless of BMI and A1c
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.
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We remain steadfast in our conviction that the formula for lasting success is to stay focused, think long-term, and do business in a financially, socially, and environmentally responsible way. With a US presence spanning 40 years, Novo Nordisk US is headquartered in New Jersey and employs over 10,000 people throughout the country across 12 manufacturing, R&D and corporate locations in eight states plus Washington DC. For more information, visit Facebook, Instagram, and X. Novo Nordisk is committed to the responsible use of our semaglutide-containing medicines which represent distinct products with different indications, dosages, prescribing information, titration schedules, and delivery forms. These products are not interchangeable and should not be used outside of their approved indications. Learn more at Contacts for further informationMedia:Liz Skrbkova (US)+1 609 917 0632 USMediaRelations@ Ambre James-Brown (Global)+45 3079 9289Globalmedia@ Investors:Frederik Taylor Pitter (US) +1 609 613 0568fptr@ Jacob Martin Wiborg Rode (Global)+45 3075 5956jrde@ Sina Meyer (Global) +45 3079 6656 azey@ Ida Schaap Melvold (Global) +45 3077 5649 idmg@ Max Ung (Global)+45 3077 6414mxun@ References 1. Ozempic® (semaglutide) injection [package insert]. Plainsboro, NJ: Novo Nordisk Inc.2. Data on File.3. Wegovy® (semaglutide) injection [package insert]. Plainsboro, NJ: Novo Nordisk Inc. Novo Nordisk is a registered trademark of Novo Nordisk A/ is a registered trademark of Novo Nordisk A/S. Wegovy® is a registered trademark of Novo Nordisk A/S.© 2025 Novo Nordisk All rights reserved. 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