Treatment with canagliflozin was found to delay a rise in the biomarkers serum N-terminal pro-B type natriuretic peptide (NT-proBNP) and high-sensitivity troponin I (hsTnI) over two years in older patients with type 2 diabetes patients, according to a Late-Breaking Clinical Trial presented June 12 during the American Diabetes Association Scientific Sessions in San Diego, CA, and simultaneously published in the Journal of the American College of Cardiology.

James L. Januzzi Jr., MD, FACC, et al., looked at 666 patients with type 2 diabetes who were randomized to receive 100 or 300 mg of canagliflozin or placebo. A median percent change in serum NT-proBNP, hsTnI, soluble (s)ST2, and galectin-3 was assessed from baseline to 26, 52 and 104 weeks.

Results showed that both serum NT-proBNP and hsTnI levels increased in placebo recipients, “while canagliflozin treatment attenuated their rise.” Hodges-Lehmann estimates of the difference in median percent change between pooled canagliflozin and placebo were –15.0 percent, –16.1 percent, and –26.8 percent for NT-proBNP, and –8.3 percent, –11.9 percent, and –10.0 percent for hsTnI at weeks 26, 52, and 104, respectively (all P <0.05).

In addition, no effect of treatment with canagliflozin on concentrations of sST2 was found, and there was a “modest, nonpersistent rise” in galectin-3.

The authors conclude that although their study was “relatively modest in size,” their findings “provide support for beneficial cardiovascular effect of SGLT2 inhibitors in [patients with type 2 diabetes].”

“The study must be viewed as being extremely preliminary,” commented Kim A. Eagle, MD, MACC, editor-in-chief of ACC.org. “Showing changes in biomarkers with a pharmaceutical agent is far from showing true patient benefit in terms of clinical outcomes. More studies are needed.”

Keywords: Biomarkers, Cardiovascular System, Diabetes Mellitus, Type 2, Galectin 3, Natriuretic Peptide, Brain, Peptide Fragments, Troponin I, Metabolic Syndrome

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