Attenzione: i dati modificati non sono ancora stati salvati. Per confermare inserimenti o cancellazioni di voci è necessario confermare con il tasto SALVA/INSERISCI in fondo alla pagina
CATALOGO DEI PRODOTTI DELLA RICERCA
BACKGROUND AND PURPOSE: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-Analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus. METHODS: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-Analysis. RESULTS: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55-1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61-1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19-1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20-1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53-1.10]; n=115). The overall effects in the 4 CVOTs combined were: Total stroke (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (45 mL/min/1.73 m2]) subgroup (HRpooled, 0.50 [95% CI, 0.31-0.79]). CONCLUSIONS: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms.
Effect of SGLT2 inhibitors on stroke and atrial fibrillation in diabetic kidney disease: Results from the CREDENCE trial and meta-analysis
Zhou Z.;Jardine M. J.;Li Q.;Neuen B. L.;Cannon C. P.;De Zeeuw D.;Edwards R.;Levin A.;Mahaffey K. W.;Perkovic V.;Neal B.;Lindley R. I.;Guerrero R. A. A.;Aizenberg D.;Albisu J. P.;Alvarisqueta A.;Bartolacci I.;Berli M. A.;Bordonava A.;Calella P.;Cantero M. C.;Cartasegna L. R.;Cercos E.;Coloma G. C.;Colombo H.;Commendatore V.;Cuadrado J.;Cuneo C. A.;Cusumano A. M.;Douthat W. G.;Dran R. D.;Farias E.;Fernandez M. F.;Finkelstein H.;Fragale G.;Fretes J. O.;Garcia N. H.;Gastaldi A.;Gelersztein E.;Glenny J. A.;Gonzalez J. P.;Del Carmen Gonzalez Colaso P.;Goycoa C.;Greloni G. C.;Guinsburg A.;Hermida S.;Juncos L. I.;Klyver M. I.;Kraft F.;Krynski F.;Lanchiotti P. V.;De La Fuente R. A. L.;Marchetta N.;Mele P.;Nicolai S.;Novoa P. A.;Orio S. I.;Otreras F.;Oviedo A.;Raffaele P.;Resk J. H.;Rista L.;Papini N. R.;Sala J.;Santos J. C.;Schiavi L. B.;Sessa H.;Casabella T. S.;Ulla M. R.;Valdez M.;Vallejos A.;Villarino A.;Visco V. E.;Wassermann A.;Zaidman C. J.;Cheung N. W.;Droste C.;Fraser I.;Johnson D.;Mah P. M.;Nicholls K.;Packham D.;Proietto J.;Roberts A.;Roger S.;Tsang V.;Raduan R. A.;Da Costa F. A. A.;Amodeo C.;Turatti L. A. A.;Bregman R.;Sanches F. C. C.;Canani L. H.;Chacra A. R.;Borges J. L. C.;Vencio S. A. C.;Da Silva Franco R. J.;D'Avila D.;De Souza Portes E.;De Souza P.;Deboni L. M.;Filho F. F.;Neto B. G.;Gomes M.;Kohara S. K.;Keitel E.;Saraiva J. F. K.;Lisboa H. R. K.;De Carvalho Contieri F. L.;Milagres R.;Junior R. M.;De Brito C. M.;Hissa M. N.;Sabbag A. R. N.;Noronha I.;Panarotto D.;Filho R. P.;Pereira M. A.;Saporito W.;Scotton A. S.;Schuch T.;De Almeida R. S.;Ramos C. S.;Felicio J. S.;Thome F.;Hachmann J. C. T.;Yamada S.;Hayashida C. Y.;Petry T. B. Z.;Zanella M. T.;Andreeva V.;Angelova A.;Dimitrov S.;Genadieva V.;Genova-Hristova G.;Hristozov K.;Kamenov Z.;Koundurdjiev A.;Lozanov L.;Margaritov V.;Nonchev B.;Rangelov R.;Shinkov A.;Temelkova M.;Velichkova E.;Yakov A.;Aggarwal N.;Aronson R.;Bajaj H.;Cherney D.;Chouinard G.;Conway J.;Cournoyer S.;DaRoza G.;De Serres S.;Dube F.;Goldenberg R.;Gupta A.;Gupta M.;Henein S.;Khandwala H.;Leiter L.;Levin A.;Madore F.;Mc-Mahon A.;Muirhead N.;Pichette V.;Rabasa-Lhoret R.;Steele A.;Tangri N.;Torshizi A.;Woo V.;Zalunardo N.;Montenegro M. A. F.;Jorquera J. G. G.;Farina M. M.;Gajardo V. S.;Vejar M.;Chen N.;Chen Q.;Gan S.;Kong Y.;Li D.;Li W.;Li X.;Lin H.;Liu J.;Lu W.;Mao H.;Ren Y.;Song W.;Sun J.;Sun L.;Tu P.;Wang G.;Yang J.;Yin A.;Yu X.;Zhao M.;Zheng H.;Mendoza J. L. A.;Arcos E.;Avendano J.;Ruiz J. E. A. D.;Ortiz L. H. G.;Gonzalez A.;Triana E. H.;Higuera J. D.;Malaver N.;De Salazar D. I. M.;Rosero R.;Lozano M. A. T.;Cometa L. V.;Valenzuela A.;Alonso R. D. V.;Villegas I.;Yupanqui H.;Bartaskova D.;Barton P.;Belobradkova J.;Dohnalova L.;Drasnar T.;Ferkl R.;Halciakova K.;Klokocnikova V.;Kovar R.;Lastuvka J.;Lukac M.;Pesickova S.;Peterka K.;Pumprla J.;Rychlik I.;Saudek F.;Tesar V.;Valis M.;Weiner P.;Zemek S.;Alamartine E.;Borot S.;Cariou B.;Dussol B.;Fauvel J. -P.;Gourdy P.;Klein A.;Le Meur Y.;Penfornis A.;Roussel R.;Saulnier P. -J.;Thervet E.;Zaoui P.;Burst V.;Faghih M.;Faulmann G.;Haller H.;Jerwan-Keim R.;Maxeiner S.;Paschen B.;Plassmann G.;Rose L.;Orellana R. A. G.;Haase F. P.;Diaz J. P. M.;Roca L. A. R.;Arenales J. A. S.;Polo J. V. S.;Juarez E. T.;Csecsei G.;Csiky B.;Danos P.;Deak L.;Dudas M.;Harcsa E.;Keltai K.;Keresztesi S.;Kiss K.;Konyves L.;Major L.;Mileder M.;Molnar M.;Mucsi J.;Oroszlan T.;Ory I.;Paragh G.;Peterfai E.;Petro G.;Revesz K.;Takacs R.;Vangel S.;Vasas S.;Zsom M.;Oomman A.;Raju S. B.;Dewan D.;Fernando M. E.;Gopalakrishnan N.;Gracious N.;Alva H.;Jain D.;Keshavamurthy C. B.;Khullar D.;Sahay M.;Peringat J.;Prasad N.;Rao K. S.;Reddy S.;Melemadathil S.;Sudhakar B.;Vyasam R. C.;Bonadonna R.;Castellino P.;Ceriello A.;Chiovato L.;De Cosmo S.;De Nicola L.;Derosa G.;Carlo A. D.;Cianni G. D.;Frasca G.;Fuiano G.;Gambaro G.;Garibotto G.;Giorda C.;Malberti F.;Mandreoli M.;Mannucci E.;Orsi E.;Piatti P.;Santoro D.;Sasso F. C.;Serviddio G.;Stella A.;Trevisan R.;Veronelli A. M.;Zanoli L.;Akiyama H.;Aoki H.;Asano A.;Iitsuka T.;Kajiyama S.;Kashine S.;Kawada T.;Kodera T.;Kono H.;Koyama K.;Kumeda Y.;Miyauchi S.;Mizuyama K.;Niiya T.;Oishi H.;Ota S.;Sakakibara T.;Takai M.;Tomonaga O.;Tsujimoto M.;Wada T.;Wakasugi M.;Wakida Y.;Watanabe T.;Yamada M.;Yanagida K.;Yanase T.;Yumita W.;Gaupsiene E.;Kozloviene D.;Navickas A.;Urbanaviciene E.;Ghani R. A.;Kadir K. A.;Ali N.;Yusof M. D. C.;Gan C. L.;Ismail M.;Kong W. Y.;Lam S. W.;Lee L. Y.;Lim S. K.;Loh C. L.;Manocha A. B.;Ng K. S.;Ahmad N. N. F. N.;Ratnasingam V.;Shudim S. S. B.;Vengadasalam P.;Munoz L. D. A.;Salazar M. A.;Cruz J. B.;Soto M. B.;Ramos J. C.;Wong A. C.;Rotter J. R. C.;Escalante T. D.;Sosa F. E. E.;Lozano F. F.;Cervera L. F. F.;Baron P. F.;Ballesteros C. G.;Rangel J. D. G.;Jimenez L. E. H.;Santana S. S. I.;Flores F. J.;Molina H. L.;Ceballos R. I. L.;Del Campo Blanco B. M.;Franco G. M.;Loza O. T. M.;Rocha C. M.;Vera G. O.;Castellanos R. O.;Calcaneo J. P.;Rosano M. A. R.;Pattzi H. R.;Guzman J. R.;Joerg I. E. R.;Sanchez S. B. S.;Mijangos J. H. S.;Sanson P. S.;Tamayo Y Orozco J. A.;Chavez E. T.;Cepeda A. V.;Carrillo L. V.;Mesa J. V.;Escobedo R. Z.;Baker J.;Noonan P.;Scott R.;Walker R.;Watson E.;Williams M.;Young S.;Abejuela Z.;Agra J.;Aquitania G.;Caringal C.;Comia R. S.;Santos L. D.;Gomez O.;Jimeno C.;Santos F.;Tan G.;Tolentino M.;Yao C.;Yap Y. E.;Ygpuara M. D. L.;Bijata-Bronisz R.;Hotlos L.;Januszewicz A.;Kaczmarek B.;Kaminska A.;Lazuka L.;Madej A.;Mazur S.;Mlodawska-Choluj D.;Nowicki M.;Orlowska-Kowalik G.;Popenda G.;Rewerska B.;Sowinski D.;Angelescu L. M.;Anghel V.;Avram R. -I.;Busegeanu M. -M.;Cif A.;Cosma D.;Crisan C.;Demian L. D.;Ferariu I. E.;Halmagyi I.;Hancu N.;Munteanu M.;Negru D.;Onaca A. G.;Petrica L.;Popa A. R.;Ranetti A. -E.;Serafinceanu C.;Toarba C.;Agafyina A.;Barbarash O.;Barysheva O.;Chizhov D.;Dobronravov V.;Dreval A.;Glinkina I.;Grineva E.;Khirmanov V.;Kolmakova E.;Koroleva T.;Kvitkova L.;Marasaev V.;Mkrtumyan A.;Morugova T.;Nagibovich G.;Nagibovich O.;Nedogoda S.;Osipova I.;Raskina T.;Samoylova Y.;Sazonova O.;Shamkhalova M.;Shutemova E.;Shwartz Y.;Uriasyev O.;Vorobyev S.;Zateyshchikova A.;Zateyshshikov D.;Zykova T.;Antic S.;Djordjevic M.;Kendereski A.;Lalic K.;Lalic N.;Popovic-Radinovic V.;Babikova J.;Benusova O.;Buganova I.;Culak J.;Dzupina A.;Dzuponova J.;Fulop P.;Ilavska A.;Martinka E.;Ochodnicka Z.;Pella D.;Smatanova I.;Ahmed F.;Badat A.;Breedt J.;Distiller L.;Govender V.;Govender R.;Joshi M.;Jurgens J.;Latiff G.;Lombard L.;Mookadam M.;Ngcakani N.;Nortje H.;Oosthuizen H.;Pillay-Ramaya L.;Prozesky H.;Reddy J.;Rheeder P.;Seeber M.;Chae D. -W.;Cho Y. M.;Jeong I. -K.;Kim S. G.;Kim Y. H.;Kwon H. -S.;Kwon M. J.;Lee B. -W.;Lee J.;Lee M. -K.;Nam M. -S.;Oh K. -H.;Park C. -Y.;Park S. -H.;Yoon K. H.;Garcia P. A.;Mercadal L. A.;Barrios C.;Castro F. C.;Guldris S. C.;Lopez M. D.;De Los Rios J. E.;Fresnedo G. F.;Serrano A. G.;Garcia I.;Martinez F. J. G.;Gimeno J. E. J.;Mendoza M. L.;Marin T. M.;Portillo C. M.;Vila M. A. M.;Torres M. M.;Iglesias J. N.;Perez J. P.;Vera M. P.;Perez J. M. P.;Simon M. A. Q.;Canonge R. S.;Gonzalez A. S.;Riera M. T.;Madueno F. J. T.;Plaza M. V.;Chang C. -T.;Chuang L. -M.;Hsia T. -L.;Hsieh C. -H.;Hwang S. -J.;Lin C. -C.;Lu Y. -C.;Sheu W. H. -H.;Barna O.;Bilyk S. D.;Botsyurko V.;Dudar I.;Fushtey I.;Godlevska O.;Golovchenko O.;Gyrina O.;Kazmirchuk A.;Kolesnyk M.;Komisarenko I.;Korzh O.;Kravchun N.;Legun O.;Mankovskyy B.;Martynyuk L.;Mostovoy Y.;Pashkovska N.;Pererva L.;Pertseva T.;Samoylov O.;Smirnov I.;Svyshchenko Y.;Tomashkevych H.;Topchii I.;Tryshchuk N.;Tseluyko V.;Vizir V.;Vlasenko M.;Zlova T.;Zub L.;Abusnana S.;Railey M.;Abouglila K.;Ainsworth P.;Ali Z.;Arutchelvam V.;Barnard M.;Bellary S.;Davies E.;Davies M.;Davies S.;Dawson A.;Kossi M. E.;English P.;Fraser D.;Gnudi L.;Gunstone A.;Hall T.;Hanif W.;Jackson A.;Johnson A.;Joseph F.;Krishnan S.;Kumwenda M.;MacDougall I.;Nixon P.;O'Hare J.;Philip S.;Ramtoola S.;Saxena M.;Sennik D.;Simon G.;Singh B.;Stephens J.;Strzelecka A.;Symonds R.;Turner W.;Wahba M.;Wakeling J.;Wheeler D.;Winocour P.;Abdallah J.;Abdullah R.;Abramowitz M.;Acosta I.;Aiello J.;Akright L.;Akyea-Djamson A.;Alappan R.;Alicic R.;Al-Karadsheh A.;Allison D. C.;Arauz-Pacheco C.;Arfeen S.;Arif A.;Arvind M.;Atray N.;Awad A.;Bakris G.;Barnhill P.;Barranco E.;Barrera C.;Beacom M.;Behara V.;Belo D.;Bentley-Lewis R.;Berenguer R.;Bermudez L.;Bernardo M.;Biscoveanu M.;Bowman-Stroud C.;Brandon D.;Brusco O.;Busch R.;Canaan Y.;Chilito A.;Christensen T.;Christiano C.;Christofides E.;Chuateco C.;Cohen K.;Cohen R.;Cohen-Stein D.;Cook C.;Coyne D.;Daboul N.;Darwish R.;Daswani A.;Deck K.;Desouza C.;Dev D.;Dhillon M.;Dua S.;Eder F.;Elosegui A. M.;El-Shahawy M.;Ervin J.;Esquenazi A.;Evans J.;Fishbane S.;Frias J.;Galindo-Ramos E.;Galphin C.;Ghazi A.;Gonzalez E.;Gorson D.;Gowda A.;Greco B.;Grubb S.;Gulati R.;Hammoud J.;Handelsman S.;Hartman I.;Hershon K.;Hiser D.;Hon G.;Jacob R.;Jaime M.;Jamal A.;Kaupke C.;Keightley G.;Kern E.;Khanna R.;Khitan Z.;Kim S.;Kopyt N.;Kovesdy C.;Krishna G.;Kropp J.;Kumar A.;Kumar J.;Kumar N.;Kusnir J.;Lane W.;Lawrence M.;Lehrner L.;Lentz J.;Levinson D.;Lewis D.;Liss K.;Maddux A.;Maheshwari H.;Mandayam S.;Marar I.;Mehta B.;Middleton J.;Mordujovich J.;Moreda R.;Moustafa M.;Trenche S. M.;Narayanan M.;Narvarte J.;Nassar T.;Newman G.;Nichol B.;Nicol P.;Nisnisan J.;Nossuli A. K.;Obialo C.;Olelewe S.;Oliver M.;O'Shaughnessy A.;Padron J.;Pankhaniya R.;Parker R.;Patel D.;Patel G.;Patel N.;Pavon H.;Perez A.;Perez C.;Perlman A.;Pettis K.;Pharr W.;Phillips A.;Purighalla R.;Quesada-Suarez L.;Ranjan R.;Rastogi S.;Reddy J.;Rendell M.;Rich L.;Robinson M.;Rodriguez H.;Rosas S.;Saba F.;Sankaram R.;Sarin R.;Schreiman R.;Scott D.;Sekkarie M.;Sensenbrenner J.;Shakeel M.;Shanik M.;Shaw S.;Smith S.;Solomon R.;Sprague A.;Spry L.;Suchinda P.;Sultan S.;Surampudi P.;Sussman S.;Tan A.;Terrelonge A.;Thompson M.;Trespalacios F.;Trippe B.;Trueba P.;Twahirwa M.;Updegrove J.;Van Buren P.;Vannorsdall M.;Varghese F.;Velasquez-Mieyer P.;Ventrapragada S.;Vukotic G.;Wadud K.;Warren M.;Watson H.;Watts R.;Weiner D.;Welker J.;Welsh J.;Williams S.;Zaniewski-Singh M.
2021-01-01
Abstract
BACKGROUND AND PURPOSE: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-Analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus. METHODS: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-Analysis. RESULTS: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55-1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61-1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19-1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20-1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53-1.10]; n=115). The overall effects in the 4 CVOTs combined were: Total stroke (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (45 mL/min/1.73 m2]) subgroup (HRpooled, 0.50 [95% CI, 0.31-0.79]). CONCLUSIONS: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms.
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/1144238
Citazioni
ND
81
77
social impact
Conferma cancellazione
Sei sicuro che questo prodotto debba essere cancellato?
simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.
