Mechanisms Connecting Diabetes Mellitus and Obesity
Obesity has a close relationship with insulin resistance and diabetes mellitus (DM); weight gain is associated with a higher incidence of both type 1 and type 2 DM. In the development of type 2 DM, depletion of pancreatic β-cells plays a crucial role, which can no longer produce sufficient insulin to maintain glucose homeostasis. The development of diabetes is much more likely if β-cell failure is accompanied by increased insulin resistance. In obese patients, there is a higher proportion of unsaturated fatty acids, glycerol, pro-inflammatory cytokines, hormones, and other substances in the blood, which have a fundamental impact on insulin resistance.
Beta-blockers in Patients After MI
Beta-blockers (BB) are a cornerstone in the management of heart failure, and their effects in acute coronary syndrome (ACS) are well studied. Oral BBs are an essential part of primary pharmacotherapy and secondary prevention after MI, regardless of its severity. Administration of BBs is recommended early after MI, unless contraindicated.
According to the European Society of Cardiology (ESC) guidelines for the management of MI issued in 2017, routine administration of BBs should be considered for patients with ST-segment elevation and is recommended for patients with reduced LVEF. However, there is still a lack of data on the use of bisoprolol in acute situations when patients are admitted to intensive care units with left ventricular systolic dysfunction following recent ACS.
For these reasons, the authors of the below-described study evaluated the impact of one-year treatment with bisoprolol on heart rate, LVEF, and metabolic indicators (levels of HbA1c and lipid profile) in patients after ACS with LVSD.
Study Methodology and Parameters
The non-interventional retrospective monocentric study was based on the collection of secondary data, in which researchers gathered demographic data and information on the occurrence of comorbidities, hemodynamics, and concomitant medication use, evaluating the effectiveness of one-year treatment in patients after ACS with LVSD (e.g., heart failure with mid-range ejection fraction [HFmrEF] or HF with reduced ejection fraction [HFrEF]; LVEF < 50%) with oral bisoprolol (1.25 mg, 2.5 mg, 5 mg, and 10 mg). Bisoprolol was introduced during hospitalization for myocardial infarction or upon hospital discharge.
Researchers assessed records of data from 400 adult patients who were first prescribed bisoprolol during hospitalization for MI with LVSD between August 2016 and June 2019. The monitored parameters included changes in LVEF, heart rate (primary endpoints), and lipid profile, HbA1c levels, and deviations of the ST segment from the J point (end of the QRS complex) after one year of treatment compared to baseline values (secondary endpoints).
Results
The median age of the study group was 55.28 ± 7.9 years, with 29.75% being women. At the end of the one-year bisoprolol treatment (median dose 4.15 + 1.4 mg), there was a significant improvement in LVEF (48.73 ± 5.5% vs. 41.45 ± 5.1%; p = 0.0001) and a significant reduction in heart rate (76.73 ± 4.6 vs. 85.06 ± 5.64 bpm; p = 0.0001) compared to baseline values. The NYHA class improved from 1.6 + 0.5 to 1.11 + 0.31.
Bisoprolol administered alongside guideline-directed medical therapy (GDMT) did not affect HbA1c, while serum lipid concentrations improved due to statin use. An electrocardiographic examination showed a smaller maximum ST deviation at the J point after one year of treatment (0.05 + 0.22 vs. 0.29 + 1.5 mm; p = 0.0001).
Conclusion
Administration of bisoprolol together with GDMT in patients after acute myocardial infarction with left ventricular systolic dysfunction significantly improved LVEF values over the course of a year. It also led to a significant reduction in heart rate and a decrease in ST segment deviation at the J point without causing adverse effects related to lipid or glycated hemoglobin levels.
(esr)
Sources:
1. Sharma K., Desai H., Sharma N. et al. To evaluate the ‘real world’ clinical performance of bisoprolol in post-myocardial infarction with left-ventricular dysfunction: TENACITY Study. Cardiolog Res Cardiovasc Med 2022; 7: 182, doi: 10.29011/2575-7083.100082.
2. Ibanez B., James S., Agewall S. et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39 (2): 119–177, doi: 10.1093/eurheartj/ehx393.
Did you like this article? Would you like to comment on it? Write to us. We are interested in your opinion. We will not publish it, but we will gladly answer you.