Invokana benefits heart health in type 2 diabetes

A recent research analysis on the sodium-glucose cotransporter 2 (SGLT-2) inhibitor Invokana (canagliflozin) has revealed improvements in two important heart failure biomarkers.
The data collected by scientists at the Massachusetts General Hospital and Harvard Medical School originated from a two-year study in older patients with type 2 diabetes who had a moderate risk of cardiovascular disease (CVD).
The participants were in their sixties, had a mean HbA1c of 61.7 mmol/mol at baseline, and received either 100 mg or 300 mg of Invokana, or a placebo, for the duration of the trial.
According to the latest figures, Invokana provoked a significant reduction in the levels of a first biomarker called N-terminal pro-B-type natriuretic peptide (NT-proBNP).
NT-proBNP is, as defined in previous research from the Heart and Soul Study, a diagnostic testing tool for ventricular dysfunction, in patients with coronary heart disease (CHD).
In that hitherto study, risk ratios were low, in the range of 0.28 and 0.95, for NT-proBNP concentrations lower than 100 pg/mL and between 100 and 500 pg/mL.
With higher concentrations than 500 pg/mL, they skyrocketed up to 4.1. This is in line with previous research suggesting that NT-proBNP concentrations higher than 500 pg/mL identify dysfunction.
The second cardiac marker described in this new paper, published in the Journal of the American College of Cardiology, is known as high-sensitivity cardiac troponin I (hsTnI).
This biomarker helps diagnose cardiomyocyte injury by making light of reversible or irreversible changes to the structure of the myocard, i.e., the layer of the heart wall.
The 2017 EXAMINE trial in type 2 diabetes showed that there is a strong relationship that exists between increasing hsTnl and the incidence of CVD events through two years.
As such, patients with type 2 diabetes who have dynamic or persistently elevated hsTnI values can be at higher risk of recurrent CVD events. Invokana seems to blunt this increase in hsTnI, similar to the response in NT-proBNP.
However, the current study was restricted to older patients with type 2 diabetes and a moderately increased CV risk. It’s unclear at this time whether the findings may be generalisable to higher-CVD-risk populations.
Further beneficial effects attributed to Invokana were documented in the CANVAS trials which, paired with changes seen in the biomarkers of the current trial, suggest that SGLT2 inhibitors may prevent or delay the development of CVD disease.