Effects of Sodium-Glucose Cotransporter-2 Inhibitors on Body Composition and Fluid Status in Cardiovascular Rehabilitation Patients with Coronary Artery Disease and Heart Failure

• Published in: Medicina (Kaunas, Lithuania) Lithuania), 2024-12, Vol.60 (12), p.2096
• Main Authors: De La Flor, José C., Coto Morales, Blanca, Basabe, Elena, Rey Hernandez, María, Zamora González-Mariño, Rocío, Rodríguez Tudero, Celia, Benites Flores, Irwing, Espinoza, Carlos, Cieza Terrones, Michael, Cigarrán Guldris, Secundino, Hernández Vaquero, Jesús
• Format: Article
• Language: English
• Subjects: bioimpedance analysis; Body composition; Body fat; Body weight; Cardiovascular disease; cardiovascular rehabilitation; Care and treatment; Clinical medicine; Coronary heart disease; Coronary vessels; Dapagliflozin; Dextrose; Diabetes; Diseases; Exercise; Exercise therapy; Fitness training programs; Gastrointestinal surgery; Glucose; Health aspects; Heart failure; Kidney diseases; Magnetic resonance imaging; Medical records; Metabolism; Muscles; Musculoskeletal system; Northwest Territories; Obesity; Physical fitness; Physiological aspects; Rehabilitation; Sarcopenia; Sodium; sodium glucose cotransporter-2 inhibitors; Spain; Type 2 diabetes; type 2 diabetes mellitus; Vein & artery diseases; Weight control
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina60122096

Background and Objectives: Sodium glucose cotransporter-2 (SGLT-2) inhibitors have emerged as integral therapeutic tools in the management of patients with cardiovascular–kidney–metabolic (CKM) syndrome. In addition to their well-documented effects on lowering glucose levels and cardiovascular- and reno-protective actions, SGLT-2 inhibitors, through a reduction in body weight (BW), generate changes in the body composition and volume status that have not been clearly studied. Materials and Methods: This retrospective, observational longitudinal cohort, single-center study analyzed and compared body composition and fluid status measured by bioelectrical impedance analysis (BIA) from weeks 0 to 12 after the initiation of the cardiac rehabilitation (CR) program for coronary artery disease and heart failure in 59 patients who started treatment with SGLT-2 inhibitors (SGLT-2iG) and 112 patients without SGLT-2 inhibitors (non-SGLT-2iG). Results: Changes between the baseline and week 12 in the SGLT-2iG and non-SGLT-2iG were −0.3 L (p = 0.003) and −0.03 L (p = 0.82) in extracellular water (ECW) (p = 0.05), −0.39 L (p < 0.001) and −0.14 L (p = 0.33) in intracellular water (ICW) (p = 0.12), −0.69 (p < 0.001) and −0.16 (p = 0.52) in total body water (TBW) (p = 0.08), and −0.01 (p = 0.37) and −0.001 (p = 0.25) in the ECW/TBW ratio, respectively. After 3 months of exercise therapy in the CR program, patients in the SGLT-2iG showed a greater decrease than the non-SGLT-2iG in weight (−1.34 kg, p < 0.001 vs. −0.99, p = 0.02), body mass index (BMI) (−0.45 kg/m2, p < 0.001 vs. −0.38, p = 0.004), arm circumference (−0.57 cm, p = 0.008 vs. −0.12 cm, p = 0.21), waist circumference (−1.5 cm, p = 0.04 vs. −0.11 cm, p = 0.83), systolic blood pressure (SBP) (−8.9 mmHg, p = 0.049 vs. −4.19, p = 0.08), and diastolic blood pressure (DBP) (−5.15, p = 0.03 vs. −2.85, p = 0.01). The bioelectrical impedance analysis (BIA) revealed a significant decrease in body fat mass (BFM) and visceral fat area, without a loss of lean body mass (LBM) or skeletal muscle mass in the SGLT-2iG. Conclusions: SGLT-2 inhibitors exert beneficial effects on body compartments and volume status. Although they induce modest weight loss, this appears to be mainly directed at ECW, BFM, and visceral fat, without a loss of LBM nor skeletal muscle mass, which could contribute to the observed CKM benefits.