Dapagliflozin for heart failure according to body mass index: the DELIVER trial.
Dapagliflozin for heart failure according to body mass index: the DELIVER trial.
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根据体重指数，达格列净治疗心力衰竭：DELIVER试验。
DOI：
10.1093/eurheartj/ehac481
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发表时间：
2022-11-01
影响因子：
39.3
通讯作者：
McMurray, John Jv
中科院分区：
文献类型：
--
作者：
Adamson, Carly;Kondo, Toru;Jhund, Pardeep;de Boer, Rudolf A.;Honorio, Jose Walter Cabrera;Claggett, Brian;Desai, Akshay S.;Gamba, Marco Antonio Alcocer;Al Habeeb, Waleed;Hernandez, Adrian F.;Inzucchi, Silvio E.;Kosiborod, Mikhail N.;Lam, Carolyn S. P.;Langkilde, Anna Maria;Lindholm, Daniel;Bachus, Erasmus;Litwin, Sheldon E.;Martinez, Felipe;Petersson, Magnus;Shah, Sanjiv J.;Vaduganathan, Muthiah;Vinh, Pham Nguyen;Wilderang, Ulrica;Solomon, Scott D.;McMurray, John Jv
肥胖很常见，并且与射血分数保留的心力衰竭（HFpEF）的独特表型特征相关。因此，了解新疗法对肥胖 HFpEF 患者的疗效和安全性非常重要。在达格列净改善保留射血分数心力衰竭患者生命的评估试验中，根据患者的体重指数（BMI）检查了达格列净的效果。体重指数按世界卫生组织 (WHO) 类别进行分析，并使用受限三次样条作为连续变量。体重指数范围为15.2至50 kg/m2，平均值为29.8（标准偏差±6.1）kg/m2。按世界卫生组织分类，比例为： 正常体重 1343 人（21.5%）；超重 2073 人（33.1%）； I级肥胖1574人（25.2%）； II级肥胖798人（12.8%）； III 级肥胖 415 人（6.6%）。与安慰剂相比，达格列净在这些类别中降低主要结局风险的程度相似：风险比（95%置信区间）：0.89（0.69-1.15）、0.87（0.70-1.08）、0.74（0.58-0.93）、0.78（0.57-1.08）和0.72分别为 (0.47–1.08)（P 相互作用 = 0.82）。达格列净 8 个月时堪萨斯城心肌病问卷总症状评分的安慰剂校正变化分别为：0.9 (−1.1, 2.8)、2.5 (0.8, 4.1)、1.9 (−0.1, 3.8)、2.7 (−0.5, 5.8) 和 8.6 (4.0, 13.2) 分（P 相互作用 = 0.03）。 12 个月时安慰剂校正的体重变化为：–0.88 (−1.28, –0.47)、–0.65 (−1.04, –0.26)、–1.42 (−1.89, –0.94)、–1.17 (−1.94, –0.40) 和 –2.50 (−4.4, –0.64) kg（P 交互作用 = 0.002）。肥胖在 HFpEF 患者中很常见，并且与较高的心力衰竭住院率和较差的健康状况相关。达格列净治疗可改善整个 BMI 范围内的心血管结局，与非肥胖患者相比，使肥胖患者的症状得到更大改善，并具有适度减轻体重的额外好处。本研究的主要背景和结果摘要。 BMI，身体质量指数； CV，心血管； DELIVER，达格列净改善保留射血分数心力衰竭患者生命的评估； HFmrEF，射血分数轻度降低的心力衰竭； HFpEF，射血分数保留的心力衰竭； KCCQ-TSS，堪萨斯城心肌病问卷总症状评分。
Obesity is common and associated with unique phenotypic features in heart failure with preserved ejection fraction (HFpEF). Therefore, understanding the efficacy and safety of new therapies in HFpEF patients with obesity is important. The effects of dapagliflozin were examined according to body mass index (BMI) among patients in the Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure trial. Body mass index was analysed by World Health Organization (WHO) categories and as a continuous variable using restricted cubic splines. Body mass index ranged from 15.2 to 50 kg/m2 with a mean value of 29.8 (standard deviation ± 6.1) kg/m2. The proportions, by WHO category, were: normal weight 1343 (21.5%); overweight 2073 (33.1%); Class I obesity 1574 (25.2%); Class II obesity 798 (12.8%); and Class III obesity 415 (6.6%). Compared with placebo, dapagliflozin reduced the risk of the primary outcome to a similar extent across these categories: hazard ratio (95% confidence interval): 0.89 (0.69–1.15), 0.87 (0.70–1.08), 0.74 (0.58–0.93), 0.78 (0.57–1.08), and 0.72 (0.47–1.08), respectively (P-interaction = 0.82). The placebo-corrected change in Kansas City Cardiomyopathy Questionnaire total symptom score with dapagliflozin at 8 months was: 0.9 (−1.1, 2.8), 2.5 (0.8, 4.1), 1.9 (−0.1, 3.8), 2.7 (−0.5, 5.8), and 8.6 (4.0, 13.2) points, respectively (P-interaction = 0.03). The placebo-corrected change in weight at 12 months was: –0.88 (−1.28, –0.47), –0.65 (−1.04, –0.26), –1.42 (−1.89, –0.94), –1.17 (−1.94, –0.40), and –2.50 (−4.4, –0.64) kg (P-interaction = 0.002). Obesity is common in patients with HFpEF and is associated with higher rates of heart failure hospitalization and worse health status. Treatment with dapagliflozin improves cardiovascular outcomes across the spectrum of BMI, leads to greater symptom improvement in patients with obesity, compared with those without, and has the additional benefit of causing modest weight loss. Summary of the key background and findings of this study. BMI, body mass index; CV, cardiovascular; DELIVER, Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure; HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; KCCQ-TSS, Kansas City Cardiomyopathy Questionnaire Total Symptom Score.
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DOI：
10.1111/obr.12358
发表时间：
2016-03
期刊：
Obesity reviews : an official journal of the International Association for the Study of Obesity
影响因子：
--
作者：
Heymsfield SB;Peterson CM;Thomas DM;Heo M;Schuna JM Jr
通讯作者：
Schuna JM Jr
DOI：
10.1161/circimaging.113.000532
发表时间：
2013-09
期刊：
Circulation. Cardiovascular imaging
影响因子：
--
作者：
Neeland IJ;Gupta S;Ayers CR;Turer AT;Rame JE;Das SR;Berry JD;Khera A;McGuire DK;Vega GL;Grundy SM;de Lemos JA;Drazner MH
通讯作者：
Drazner MH
影响因子：
158.5
作者：
Solomon, S. D.;McMurray, J. J., V;Langkilde, A. M.
通讯作者：
Langkilde, A. M.
通过保留和减少的射血分数来预测心力衰竭：心力衰竭亚型的国际合作。
DOI：
10.1161/circheartfailure.115.003116
发表时间：
2016-06
期刊：
Circulation. Heart failure
影响因子：
--
作者：
Ho JE;Enserro D;Brouwers FP;Kizer JR;Shah SJ;Psaty BM;Bartz TM;Santhanakrishnan R;Lee DS;Chan C;Liu K;Blaha MJ;Hillege HL;van der Harst P;van Gilst WH;Kop WJ;Gansevoort RT;Vasan RS;Gardin JM;Levy D;Gottdiener JS;de Boer RA;Larson MG
通讯作者：
Larson MG
DOI：
10.1001/jama.2015.17346
发表时间：
2016-01-05
期刊：
JAMA
影响因子：
--
作者：
Kitzman DW;Brubaker P;Morgan T;Haykowsky M;Hundley G;Kraus WE;Eggebeen J;Nicklas BJ
通讯作者：
Nicklas BJ