African Americans have high cardiometabolic risk pre- and post-SGLT2 inhibitor initiation
medwireNews: Among people with type 2 diabetes, those of African American descent have a higher cardiometabolic risk factor burden than Caucasians at the time of starting treatment with a sodium-glucose co-transporter (SGLT)2 inhibitor and this might affect long-term treatment response, study findings suggest.
Sanjoy Paul (The Royal Melbourne Hospital, Victoria, Australia) and colleagues found that, at the time of starting the oral antidiabetic treatment, 31% of African Americans had uncontrolled systolic blood pressure (SBP), defined as 130 mmHg or above for people with atherosclerotic cardiovascular disease and 140 mmHg or above for those without. This was significantly more than the 24% of Caucasians with uncontrolled SBP, despite similar percentages (89% and 87%, respectively) receiving appropriate antihypertensive therapy.
African Americans were also more likely to have poor control of their low-density lipoprotein cholesterol (LDL-C) levels (≥70/100 mg/dL), at 51% versus 42% of Caucasians.
However, the proportions of people with uncontrolled non-high-density lipoprotein cholesterol (HDL-C; ≥100/130 mg/dL) were similar (49% and 51%, respectively), and Caucasians were significantly more likely than African Americans to have uncontrolled triglyceride levels (<150 mg/dL), at 62% versus 32%.
“Underlying cardiometabolic differences between ethnicities may result in different outcomes of treatment,” Paul and colleagues write in Diabetes, Obesity and Metabolism.
They observe that SGLT2 inhibitor treatment has been shown to improve cardiometabolic risk factors in general, but that “the evidence of the extra-glycemic benefits of treatment with such therapy among [African Americans] with type 2 diabetes is scarce.”
To look at the cardiometabolic effects of SGLT2 inhibitor treatment in African Americans with type 2 diabetes, Paul and team used a nationally representative sample of US electronic medical records to identify 10,004 African American and 72,690 Caucasian adults with type 2 diabetes who initiated a SGLT2 inhibitor between 2013 and 2018.
While similar reductions in glycated hemoglobin (HbA1c), systolic blood pressure, LDL-C, and bodyweight were seen among the two study groups at the 6-month follow-up, African Americans were significantly less likely than Caucasians to achieve sustained control a further 12 months on.
Odds ratios for sustained control of HbA1c, systolic blood pressure, LDL-C, and bodyweight at 18 months were a respective 0.67, 0.67, 0.77, and 0.81 for African Americans versus Caucasians.
Paul and team report that there was a “significantly high persistent risk factor burden” across ethnicities despite appropriate treatment with oral antidiabetic, antihypertensive, and lipid-lowering drugs.
While there was a similar effectiveness of SGLT2 inhibitor treatment, African Americans “continued to have worse cardiometabolic risk factor burden post [SGLT2 inhibitor] initiation,” and were less likely to achieve “sustainable cardiometabolic risk factor control” than Caucasians, they say.
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