Sodium-glucose co-transporter-2 inhibitor mediated cardio-protection: does increase of hematocrit finally matter? Sub-analysis of a prospective, observational study

Hematocrit increase with sodium-glucose co-transporter-2 (SGLT-2) inhibitors has been proposed as a potential mechanism implicated in the well-established cardio- and reno-protection with this drug class [1]. According to a recent, large meta-analysis of randomized controlled trials in a total of 14,478 participants, SGLT-2 inhibitors led to a significant increase in hematocrit by 1.32% and in hemoglobin by 0.56 g/dl [2]. Increases in erythropoiesis and red-blood cell count, along with decreases in hepcidin, ferritin and transferrin saturation levels, have been observed [3–5]. In the present sub-analysis of a real-world study performed in the context of the COVID-19 pandemic we sought to determine the effect of different SGLT-2 inhibitors on hematocrit levels and their association with established cardiovascular risk factors.
This is a sub-analysis of a single-center, prospective, observational study, conducted in the Diabetes Center of the Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital “Hippokration”, between January 2020 and August 2021. The study protocol was approved by the Ethics Committee of the Medical School, Aristotle University of Thessaloniki (protocol number: 4/17.7.2019). Study procedures were performed strictly in accordance with the principles outlined in the Declaration of Helsinki. The study has been registered in the International Standard Registered Clinical/soCial sTudy Number (ISRCTN) registry (registration number ISRCTN88851713). Our initial study aims to identify the effect of long-term treatment with SGLT-2 inhibitors on ambulatory arterial stiffness indices.
Adult subjects aged 18–75 years, with an established diagnosis of type 2 diabetes mellitus (T2DM) (≥ 12 months), glycated hemoglobin (HbA1c) value ranging between 6.55 and 10.0%, stable antidiabetic and antihypertensive treatment over the last 6 months and an indication for the initiation or addition of new antidiabetic therapy with a SGLT-2 inhibitor according to the treating physician’s discretion were eligible to participate, after providing written informed consent. Blood sampling was performed for all patients, after overnight fasting, both at visit 1 (prior to initiation of a SGLT-2 inhibitor) and at visit 2 (planned to be performed 6 months after visit 1).
Enrolled participants were prescribed either dapagliflozin 10 mg or empagliflozin 10 mg once daily, according to the treating...


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