Aim: study the effect of Sacubitril/valsartan (SV) combination therapy on cardio-renal (CR) biomarkers in T2DM with preserved ejection fraction (pEF); diastolic dysfunction and or LVH on 2D echocardiogram (E) and elevated N-terminal prohormone B-type natriuretic peptide (NT-proBNP) >125.

Methodology: between July and Sept 2018, 109 T2DM patients aged 18-75 yrs, irrespective of baseline A1c, receiving SV were identified. Patients were analysed every 2-3months for CR biomarkers (body mass index (BMI), A1c, systolic (S) BP, diastolic (D) BP, Lipid profile (TC, LDL, TG, HDL), Hs-CRP, NT-ProBNP, creatinine, eGFR and microalbumin/creatinine ratio {UACR} and data presented at 1 yr. T2DM with H/O IHD, reduced EF(<50%) or wall motion abnormalities on E, malignancy, major surgery, hyperkalemia >5.5Meq/L and eGFR<45 were excluded. Baseline characteristics were analyzed using descriptive statistics. Continuous variables were analysed using paired and unpaired t-test expressed as mean ± standard error. For interaction between drug class, ANOVA was used and p value <0.05 was considered significant (S).

Results: Baseline characteristics: Male 43%, Female 66%. Avg (age 63.16 ±8.325yrs, BMI 30.45±5.52, A1c% 7.1±1.2, egfr 90.31±30.45, UACR mg/gm 180.07±553.4, hs-CRP mg/dl 2.53±3.41, NT-proBNP 370.07±543.30 Ng/L). 64.2% received canagliflozin, 11.9% liraglutide, 94.5% Metformin, 61.5% gliptins, 65.1% gliclazide, 44% calcium channel blockers and 100% statin (rosuvastatin) Baseline (B) to 1yr: There was S reduction in SBP, DBP, A1c, TC, LDL, HDL, UACR, hs-CRP and NT-ProBNP NT-proBNP: there was S reduction from B to 3 mths (84.26±31.86, p-0.009), 6mth - 12 mths (39.95±17.40,p-0.024) and B-12mths (155.69±744.10,p-0.001). There was no diff seen 3-6mths (38.09±38.03, p-0.320). There was an interaction seen with Liraglutide in terms of NT-proBNP and UACR.

Conclusion: SV may be effective in reducing NT-ProBNP in T2DM with pEF


V. Gupta: None. V. Teli: None.

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