@article{MTMT:31300303, title = {Influence of Microvascular Disease on Cardiovascular Events in Type 2 Diabetes}, url = {https://m2.mtmt.hu/api/publication/31300303}, author = {Verma, S. and Wanner, C. and Zwiener, I. and Ofstad, A.P. and George, J.T. and Fitchett, D. and Zinman, B.}, doi = {10.1016/j.jacc.2019.03.002}, journal-iso = {J AM COLL CARDIOL}, journal = {JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY}, volume = {73}, unique-id = {31300303}, issn = {0735-1097}, year = {2019}, eissn = {1558-3597}, pages = {2780-2782}, orcid-numbers = {Gerő, László/0000-0002-7584-9338; Tabák, Ádám/0000-0002-6234-3936} } @article{MTMT:31307246, title = {Empagliflozin in women with type 2 diabetes and cardiovascular disease - an analysis of EMPA-REG OUTCOME®}, url = {https://m2.mtmt.hu/api/publication/31307246}, author = {Zinman, Bernard and Inzucchi, Silvio E and Wanner, Christoph and Hehnke, Uwe and George, Jyothis T and Johansen, Odd Erik and Fitchett, David}, doi = {10.1007/s00125-018-4630-2}, journal-iso = {DIABETOLOGIA}, journal = {DIABETOLOGIA}, volume = {61}, unique-id = {31307246}, issn = {0012-186X}, abstract = {The global epidemic of type 2 diabetes affects women and men equally; however, the relative impact on the cardiovascular (CV) system appears greater for women than men when compared with peers without diabetes. Furthermore, women are often under-represented in CV outcome trials, resulting in less certainty about the impact of CV prevention therapies across the sexes. The EMPA-REG OUTCOME® trial, which included 28.5% women, found that empagliflozin, given in addition to standard of care, reduced the risk of CV death by 38%, heart failure (HF) hospitalisation by 35% and a composite endpoint for incident or worsening nephropathy by 39%. Here we report a secondary analysis of the trial to determine the relative effects of empagliflozin in women vs men.The population studied were individuals with type 2 diabetes (HbA1c 53-86 mmol/mol [7-10%] and eGFR >30 ml min-1 [1.73 m]-2), with established atherosclerotic CV disease. Individuals were randomised to receive empagliflozin 10 mg or 25 mg, or placebo once daily in addition to standard of care, and followed. The trial continued until ≥691 individuals had experienced an adjudicated event included in the primary outcome. All CV outcome events, including HF hospitalisations and deaths were prospectively adjudicated by blinded clinical events committees.At baseline, the demographic profile of the 2004 women (age ± standard deviation 63.6 ± 8.8 years) compared with the 5016 men (age 63.0 ± 8.6 years) in the trial was largely similar, with the exception that LDL-cholesterol was numerically higher in women (2.5 ± 1.0 vs 2.1 ± 0.9 mmol/l), consistent with lower rates of lipid-lowering therapies (75.4% vs 83.2%). Women were also less likely to have smoked (31.5% vs 69.9%). The annualised incidence rate for women in the placebo group was numerically lower than in men for CV death (1.58% vs 2.19%), numerically higher for HF hospitalisation (1.75% vs 1.33%) and similar for renal events (7.22% vs 7.75%). We did not detect any effect modification by sex within the statistical power restrictions of the analysis for CV death, HF hospitalisation and incident or worsening nephropathy (interaction p values 0.32, 0.20 and 0.85, respectively). Compared with placebo, empagliflozin increased the rates of genital infections in both women (2.5% vs 10.0%) and men (1.5% vs 2.6%).CV death, HF hospitalisation and incident or worsening nephropathy rate reductions induced by empagliflozin were not different between women and men.}, keywords = {MORTALITY; WOMEN; heart failure; cardiovascular disease; Type 2 diabetes; SGLT2 inhibition}, year = {2018}, eissn = {1432-0428}, pages = {1522-1527}, orcid-numbers = {Gerő, László/0000-0002-7584-9338; Tabák, Ádám/0000-0002-6234-3936} } @article{MTMT:31209141, title = {Effects of empagliflozin on risk for cardiovascular death and heart failure hospitalization across the spectrumof heart failure risk in the EMPA-REG OUTCOME (R) trial}, url = {https://m2.mtmt.hu/api/publication/31209141}, author = {Fitchett, D and Butler, J and van de Borne, P and Zinman, B and Lachin, JM and Wanner, C and Woerle, HJ and Hantel, S and George, JT and Johansen, OE and Inzucchi, SE}, doi = {10.1093/eurheartj/ehx511}, journal-iso = {EUR HEART J}, journal = {EUROPEAN HEART JOURNAL}, volume = {39}, unique-id = {31209141}, issn = {0195-668X}, abstract = {Aims Empagliflozin reduced the risk of cardiovascular (CV) death and heart failure (HF) hospitalizations in patients with type 2 diabetes (T2D) and established CV disease (CVD) in the EMPA-REG OUTCOME (R) trial. We investigated whether the benefit of empagliflozin was observed across the spectrum of HF risk. Methods and results Seven thousand and twenty patients with T2D (HbA1c 7-10% and eGFR > 30 mL/min/1.73 m(2)) were treated with empagliflozin 10 or 25 mg, or placebo once daily and followed for median 3.1 years. In patients without HF at baseline (89.9%), we derived the 5-year risk for incident HF using the 9-variable Health ABC HF Risk score [classified as low-to-average (<10%), high (10-20%), and very high (>= 20%)]. Overall, 67.2% of the population had low-to-average, 24.2% high, and 5.1% very high 5-year HF risk. Across these groups, the effect on CV death and HF hospitalization with empagliflozin was consistent [hazard ratio 0.71 (95% confidence interval: 0.52, 0.96), 0.52 (0.36, 0.75), and 0.55 (0.30, 1.00), respectively]. Effects on CV death in the ostensibly highest HF risk group (HF at baseline and/or incident HF during the trial) in whom 37.9% of the overall CV deaths occurred, was also beneficial [0.67 (0.47, 0.97)], yet, similar benefits were seen in the lower risk patients. Conclusion In patients with T2D and established CVD, a sizeable proportion without HF at baseline are at high or very high risk for HF outcomes, indicating the need for active case finding in this patient population. Empagliflozin consistently improved HF outcomes both in patients at low or high HF risk.}, keywords = {ASSOCIATION; PREDICTION; Prognosis; DIABETES-MELLITUS; hospitalization; MANAGEMENT; heart failure; cardiovascular disease; Type 2 diabetes}, year = {2018}, eissn = {1522-9645}, pages = {363-370}, orcid-numbers = {Gerő, László/0000-0002-7584-9338; Tabák, Ádám/0000-0002-6234-3936} } @article{MTMT:31209130, title = {Empagliflozin and Clinical Outcomes in Patients With Type 2 Diabetes Mellitus, Established Cardiovascular Disease, and Chronic Kidney Disease}, url = {https://m2.mtmt.hu/api/publication/31209130}, author = {Wanner, Christoph and Lachin, John M and Inzucchi, Silvio E and Fitchett, David and Mattheus, Michaela and George, Jyothis and Woerle, Hans J and Broedl, Uli C and von Eynatten, Maximilian and Zinman, Bernard}, doi = {10.1161/CIRCULATIONAHA.117.028268}, journal-iso = {CIRCULATION}, journal = {CIRCULATION}, volume = {137}, unique-id = {31209130}, issn = {0009-7322}, abstract = {Empagliflozin, a sodium-glucose cotransporter 2 inhibitor, reduced cardiovascular morbidity and mortality in patients with type 2 diabetes mellitus and established cardiovascular disease in the EMPA-REG OUTCOME trial (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients). Urinary glucose excretion with empagliflozin decreases with declining renal function, resulting in less potency for glucose lowering in patients with kidney disease. We investigated the effects of empagliflozin on clinical outcomes in patients with type 2 diabetes mellitus, established cardiovascular disease, and chronic kidney disease.Patients with type 2 diabetes mellitus, established cardiovascular disease, and estimated glomerular filtration rate (eGFR) ≥30 mL·min-1·1.73 m-2 at screening were randomized to receive empagliflozin 10 mg, empagliflozin 25 mg, or placebo once daily in addition to standard of care. We analyzed cardiovascular death, hospitalization for heart failure, all-cause hospitalization, and all-cause mortality in patients with prevalent kidney disease (defined as eGFR <60 mL·min-1·1.73 m-2 and/or urine albumin-creatinine ratio >300 mg/g) at baseline. Additional analyses were performed in subgroups by baseline eGFR (<45, 45-<60, 60-<90, ≥90 mL·min-1·1.73 m-2) and baseline urine albumin-creatinine ratio (>300, 30-≤300, <30 mg/g).Of 7020 patients treated, 2250 patients had prevalent kidney disease at baseline, of whom 67% had a diagnosis of type 2 diabetes mellitus for >10 years, 58% were receiving insulin, and 84% were taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. In patients with prevalent kidney disease at baseline, empagliflozin reduced the risk of cardiovascular death by 29% compared with placebo (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.52-0.98), the risk of all-cause mortality by 24% (HR, 0.76; 95% CI, 0.59-0.99), the risk of hospitalization for heart failure by 39% (HR, 0.61; 95% CI, 0.42-0.87), and the risk of all-cause hospitalization by 19% (HR, 0.81; 95% CI, 0.72-0.92). Effects of empagliflozin on these outcomes were consistent across categories of eGFR and urine albumin-creatinine ratio at baseline and across the 2 doses studied. The adverse event profile of empagliflozin in patients with eGFR <60 mL·min-1·1.73 m-2 was consistent with the overall trial population.Empagliflozin improved clinical outcomes and reduced mortality in vulnerable patients with type 2 diabetes mellitus, established cardiovascular disease, and chronic kidney disease.URL: https://www.clinicaltrials.gov. Unique identifier: NCT01131676.}, keywords = {MORTALITY; Treatment Outcome; hospitalization; Diabetes Mellitus, Type 2; Kidney Diseases; sodium-glucose transporter 2}, year = {2018}, eissn = {1524-4539}, pages = {119-129}, orcid-numbers = {Gerő, László/0000-0002-7584-9338; Tabák, Ádám/0000-0002-6234-3936} } @article{MTMT:30703833, title = {Empagliflozin and Kidney Function Decline in Patients with Type 2 Diabetes: A Slope Analysis from the EMPA-REG OUTCOME Trial}, url = {https://m2.mtmt.hu/api/publication/30703833}, author = {Wanner, Christoph and Heerspink, Hiddo J. L. and Zinman, Bernard and Inzucchi, Silvio E. and Koitka-Weber, Audrey and Mattheus, Michaela and Hantel, Stefan and Woerle, Hans-Juergen and Broedl, Uli C. and von Eynatten, Maximilian and Groop, Per-Henrik}, doi = {10.1681/ASN.2018010103}, journal-iso = {J AM SOC NEPHROL}, journal = {JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY}, volume = {29}, unique-id = {30703833}, issn = {1046-6673}, abstract = {Background Empagliflozin slowed the progression of CKD in patients with type 2 diabetes and cardiovascular disease in the EMPA-REG OUTCOME Trial. In a prespecified statistical approach, we assessed treatment differences in kidney function by analyzing slopes of eGFR changes.Methods Participants (n=7020) were randomized (1:1:1) to empagliflozin 10 mg/d, empagliflozin 25 mg/d, or placebo added to standard of care. We calculated eGFR slopes using random-intercept/random-coefficient models for prespecified study periods: treatment initiation (baseline to week 4), chronic maintenance treatment (week 4 to last value on treatment), and post-treatment (last value on treatment to follow-up).Results Compared with placebo, empagliflozin was associated with uniform shifts in individual eGFR slopes across all periods. On treatment initiation, adjusted mean slope (eGFR change per week, ml/min per 1.73 m(2)) decreased with empagliflozin (-0.77; 95% confidence interval, -0.83 to -0.71; placebo: 0.01; 95% confidence interval, -0.08 to 0.10; P<0.001). However, annual mean slope (ml/min per 1.73 m(2) per year) did not decline with empagliflozin during chronic treatment (empagliflozin: 0.23; 95% confidence interval, 0.05 to 0.40; placebo: -1.46; 95% confidence interval, -1.74 to -1.17; P<0.001). After drug cessation, the adjusted mean eGFR slope (ml/min per 1.73 m(2) per week) increased and mean eGFR returned toward baseline level only in the empagliflozin group (0.56; 95% confidence interval, 0.49 to 0.62; placebo -0.02; 95% confidence interval, -0.12 to 0.08; P<0.001). Results were consistent across patient subgroups at higher CKD risk.Conclusions The hemodynamic effects of empagliflozin, associated with reduction in intraglomerular pressure, may contribute to long-term preservation of kidney function.}, keywords = {diabetes mellitus; chronic kidney disease; randomized controlled trials}, year = {2018}, eissn = {1533-3450}, pages = {2755-2769}, orcid-numbers = {Gerő, László/0000-0002-7584-9338; Tabák, Ádám/0000-0002-6234-3936} } @article{MTMT:31308918, title = {Empagliflozin and Cardiovascular Outcomes in Asian Patients With Type 2 Diabetes and Established Cardiovascular Disease ― Results From EMPA-REG OUTCOME® ―}, url = {https://m2.mtmt.hu/api/publication/31308918}, author = {Kaku, Kohei and Lee, Jisoo and Mattheus, Michaela and Kaspers, Stefan and George, Jyothis and Woerle, Hans-Juergen}, doi = {10.1253/circj.CJ-16-1148}, journal-iso = {CIRC J}, journal = {CIRCULATION JOURNAL: OFFICIAL JOURNAL OF THE JAPANESE CIRCULATION SOCIETY}, volume = {81}, unique-id = {31308918}, issn = {1346-9843}, year = {2017}, eissn = {1347-4820}, pages = {227-234}, orcid-numbers = {Gerő, László/0000-0002-7584-9338; Tabák, Ádám/0000-0002-6234-3936} } @article{MTMT:26756488, title = {Empagliflozin and Cerebrovascular Events in Patients With Type 2 Diabetes Mellitus at High Cardiovascular Risk}, url = {https://m2.mtmt.hu/api/publication/26756488}, author = {Zinman, Bernard and Inzucchi, Silvio E and Lachin, John M and Wanner, Christoph and Fitchett, David and Kohler, Sven and Mattheus, Michaela and Biomath, Dipl and Woerle, Hans J and Broedl, Uli C and Johansen, Odd Erik and Albers, Gregory W and Diener, Hans Christoph}, doi = {10.1161/STROKEAHA.116.015756}, journal-iso = {STROKE}, journal = {STROKE}, volume = {48}, unique-id = {26756488}, issn = {0039-2499}, abstract = {Background and Purpose-In the EMPA-REG OUTCOME trial (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients), empagliflozin added to standard of care in patients with type 2 diabetes mellitus and high cardiovascular risk reduced the risk of 3-point major adverse cardiovascular events, driven by a reduction in cardiovascular mortality, with no significant difference between empagliflozin and placebo in risk of myocardial infarction or stroke. In a modified intent-to-treat analysis, the hazard ratio for stroke was 1.18 (95% confidence interval, 0.89-1.56; P= 0.26). We further investigated cerebrovascular events.}, keywords = {Blood Pressure; cardiovascular diseases; hematocrit; stroke; type 2 diabetes mellitus}, year = {2017}, eissn = {1524-4628}, pages = {1218-1225}, orcid-numbers = {Gerő, László/0000-0002-7584-9338; Tabák, Ádám/0000-0002-6234-3936} } @article{MTMT:31230059, title = {Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes}, url = {https://m2.mtmt.hu/api/publication/31230059}, author = {Wanner, Christoph and Inzucchi, Silvio E. and Lachin, John M. and Fitchett, David and von Eynatten, Maximilian and Mattheus, Michaela and Johansen, Odd Erik and Woerle, Hans J. and Broedl, Uli C. and Zinman, Bernard}, doi = {10.1056/NEJMoa1515920}, journal-iso = {NEW ENGL J MED}, journal = {NEW ENGLAND JOURNAL OF MEDICINE}, volume = {375}, unique-id = {31230059}, issn = {0028-4793}, abstract = {BACKGROUND Diabetes confers an increased risk of adverse cardiovascular and renal events. In the EMPA-REG OUTCOME trial, empagliflozin, a sodium-glucose cotransporter 2 inhibitor, reduced the risk of major adverse cardiovascular events in patients with type 2 diabetes at high risk for cardiovascular events. We wanted to determine the long-term renal effects of empagliflozin, an analysis that was a prespecified component of the secondary microvascular outcome of that trial. METHODS We randomly assigned patients with type 2 diabetes and an estimated glomerular filtration rate of at least 30 ml per minute per 1.73 m(2) of body-surface area to receive either empagliflozin (at a dose of 10 mg or 25 mg) or placebo once daily. Prespecified renal outcomes included incident or worsening nephropathy (progression to macroalbuminuria, doubling of the serum creatinine level, initiation of renal-replacement therapy, or death from renal disease) and incident albuminuria. RESULTS Incident or worsening nephropathy occurred in 525 of 4124 patients (12.7%) in the empagliflozin group and in 388 of 2061 (18.8%) in the placebo group (hazard ratio in the empagliflozin group, 0.61; 95% confidence interval, 0.53 to 0.70; P<0.001). Doubling of the serum creatinine level occurred in 70 of 4645 patients (1.5%) in the empagliflozin group and in 60 of 2323 (2.6%) in the placebo group, a significant relative risk reduction of 44%. Renal-replacement therapy was initiated in 13 of 4687 patients (0.3%) in the empagliflozin group and in 14 of 2333 patients (0.6%) in the placebo group, representing a 55% lower relative risk in the empagliflozin group. There was no significant between-group difference in the rate of incident albuminuria. The adverse-event profile of empagliflozin in patients with impaired kidney function at baseline was similar to that reported in the overall trial population. CONCLUSIONS In patients with type 2 diabetes at high cardiovascular risk, empagliflozin was associated with slower progression of kidney disease and lower rates of clinically relevant renal events than was placebo when added to standard care. (Funded by the Boehringer Ingelheim and Eli Lilly and Company Diabetes Alliance; EMPA-REG OUTCOME ClinicalTrials.gov number, NCT01131676.)}, keywords = {INHIBITION; BLOOD-PRESSURE; CARDIOVASCULAR-DISEASE; DOUBLE-BLIND; GLOMERULAR-FILTRATION-RATE; arterial stiffness; END-POINTS; intensive glucose control; ADD-ON}, year = {2016}, eissn = {1533-4406}, pages = {323-334}, orcid-numbers = {Lachin, John M./0000-0001-9838-2841; Gerő, László/0000-0002-7584-9338; Tabák, Ádám/0000-0002-6234-3936} } @article{MTMT:3078519, title = {Teljes körű GDM-szűrés értékelése a WHO és az IADPSG kritériumrendszere alapján}, url = {https://m2.mtmt.hu/api/publication/3078519}, author = {Kun, Attila and Tabák, Ádám and Sudár, Z and Tornóczky, J and Vargha, P and Kerényi, Z and Tamás, Gyula}, journal-iso = {DIABETOLOGIA HUNGARICA}, journal = {DIABETOLOGIA HUNGARICA}, volume = {22}, unique-id = {3078519}, issn = {1217-372X}, year = {2014}, eissn = {2560-0168}, pages = {201-206}, orcid-numbers = {Tabák, Ádám/0000-0002-6234-3936} } @article{MTMT:2404281, title = {Serum adiponectin levels in women with previous gestational diabetes}, url = {https://m2.mtmt.hu/api/publication/2404281}, author = {Szabó, E and Szili-Janicsek, Zsófia and Fürst, Á and Magenheim, Rita and Tänczer, Tímea and Kósa, János and Tamás, Gyula and Tabák, Ádám}, journal-iso = {DIABETOLOGIA}, journal = {DIABETOLOGIA}, volume = {56}, unique-id = {2404281}, issn = {0012-186X}, year = {2013}, eissn = {1432-0428}, pages = {S513-S513}, orcid-numbers = {Tabák, Ádám/0000-0002-6234-3936} }