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Impact of Dapagliflozin on Cardiometabolic Outcomes After Acute Myocardial Infarction According to Baseline Glycemic Status and Body Mass Index : Subanalyses of the DAPA-MI Trial

Storey, Robert F. ; Deanfield, John ; James, Stefan ; Ajjan, Ramzi A. ; Eriksson, Niclas ; Erlinge, David LU orcid ; de Belder, Mark ; Gale, Chris P. ; Zaman, Azfar and Hofmann, Robin , et al. (2025) In Journal of the American Heart Association 14(15).
Abstract

BACKGROUND: Dapagliflozin improved cardiometabolic outcomes following myocardial infarction in patients without prior type-2 diabetes (T2DM) in the DAPA-MI (dapagliflozin in patients with myocardial infarction) trial. The effect of glycemic status and body mass index (BMI) post–myocardial infarction requires elucidation. METHODS: Participants with T2DM diagnosis, without baseline hemoglobin A1c, or not receiving any study medication, were excluded. Eligible participants were categorized, according to baseline hemoglobin A1c, as normoglycemic (<5.7% [39 mmol/mol]) or prediabetes (5.7 to <6.5% [48 mmol/mol]) and according to baseline BMI (<25, 25 to <30, and ≥30 kg/m2). Hazard ratios (HRs) with 95% CIs and 1-year... (More)

BACKGROUND: Dapagliflozin improved cardiometabolic outcomes following myocardial infarction in patients without prior type-2 diabetes (T2DM) in the DAPA-MI (dapagliflozin in patients with myocardial infarction) trial. The effect of glycemic status and body mass index (BMI) post–myocardial infarction requires elucidation. METHODS: Participants with T2DM diagnosis, without baseline hemoglobin A1c, or not receiving any study medication, were excluded. Eligible participants were categorized, according to baseline hemoglobin A1c, as normoglycemic (<5.7% [39 mmol/mol]) or prediabetes (5.7 to <6.5% [48 mmol/mol]) and according to baseline BMI (<25, 25 to <30, and ≥30 kg/m2). Hazard ratios (HRs) with 95% CIs and 1-year Kaplan–Meier rates were determined for new-onset T2DM (investigator-reported or hemoglobin A1c ≥6.5%) and New York Heart Association symptom classification during follow-up. RESULTS: Of 4017 DAPA-MI participants, 3425 were eligible. In 1926 with baseline normoglycemia, new-onset T2DM occurred in 0.6% and 1.6% assigned to dapagliflozin and placebo, respectively (hazard ratio, 0.40 [95% CI, 0.15–1.03]); in 1499 with prediabetes at baseline, new-onset T2DM occurred in 10.1% and 13.1%, respectively (hazard ratio, 0.74 [05% CI, 0.55–0.99]; P interaction 0.23). One-year absolute risk reduction for new-onset T2DM was 8.1% in those with both prediabetes and BMI ≥30. Dapagliflozin reduced the occurrence of New York Heart Association class III–IV symptoms, with greater effect in those with prediabetes versus normoglycemia (P interaction 0.009). One-year absolute risk reduction for New York Heart Association class III–IV symptoms was 10.0% in those with both prediabetes and BMI ≥30. CONCLUSIONS: Dapagliflozin reduced the occurrence of new-onset T2DM following myocardial infarction, regardless of baseline hemoglobin A1c or BMI. Dapagliflozin provided greater reduction in heart failure symptom burden in those with prediabetes compared with normoglycemia.

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type
Contribution to journal
publication status
published
subject
keywords
dapagliflozin, diabetes, myocardial infarction, obesity, prediabetes
in
Journal of the American Heart Association
volume
14
issue
15
article number
e040327
publisher
Wiley-Blackwell
external identifiers
  • scopus:105012845165
  • pmid:40728174
ISSN
2047-9980
DOI
10.1161/JAHA.124.040327
language
English
LU publication?
yes
id
a92cb185-ab4b-4bd3-bd1a-18051ff77b6f
date added to LUP
2026-01-27 10:03:39
date last changed
2026-01-28 03:00:11
@article{a92cb185-ab4b-4bd3-bd1a-18051ff77b6f,
  abstract     = {{<p>BACKGROUND: Dapagliflozin improved cardiometabolic outcomes following myocardial infarction in patients without prior type-2 diabetes (T2DM) in the DAPA-MI (dapagliflozin in patients with myocardial infarction) trial. The effect of glycemic status and body mass index (BMI) post–myocardial infarction requires elucidation. METHODS: Participants with T2DM diagnosis, without baseline hemoglobin A1c, or not receiving any study medication, were excluded. Eligible participants were categorized, according to baseline hemoglobin A1c, as normoglycemic (&lt;5.7% [39 mmol/mol]) or prediabetes (5.7 to &lt;6.5% [48 mmol/mol]) and according to baseline BMI (&lt;25, 25 to &lt;30, and ≥30 kg/m<sup>2</sup>). Hazard ratios (HRs) with 95% CIs and 1-year Kaplan–Meier rates were determined for new-onset T2DM (investigator-reported or hemoglobin A1c ≥6.5%) and New York Heart Association symptom classification during follow-up. RESULTS: Of 4017 DAPA-MI participants, 3425 were eligible. In 1926 with baseline normoglycemia, new-onset T2DM occurred in 0.6% and 1.6% assigned to dapagliflozin and placebo, respectively (hazard ratio, 0.40 [95% CI, 0.15–1.03]); in 1499 with prediabetes at baseline, new-onset T2DM occurred in 10.1% and 13.1%, respectively (hazard ratio, 0.74 [05% CI, 0.55–0.99]; P interaction 0.23). One-year absolute risk reduction for new-onset T2DM was 8.1% in those with both prediabetes and BMI ≥30. Dapagliflozin reduced the occurrence of New York Heart Association class III–IV symptoms, with greater effect in those with prediabetes versus normoglycemia (P interaction 0.009). One-year absolute risk reduction for New York Heart Association class III–IV symptoms was 10.0% in those with both prediabetes and BMI ≥30. CONCLUSIONS: Dapagliflozin reduced the occurrence of new-onset T2DM following myocardial infarction, regardless of baseline hemoglobin A1c or BMI. Dapagliflozin provided greater reduction in heart failure symptom burden in those with prediabetes compared with normoglycemia.</p>}},
  author       = {{Storey, Robert F. and Deanfield, John and James, Stefan and Ajjan, Ramzi A. and Eriksson, Niclas and Erlinge, David and de Belder, Mark and Gale, Chris P. and Zaman, Azfar and Hofmann, Robin and Mellbin, Linda and Andersen, Kasper and Jiang, Yunyun and Johansson, Peter A. and Ridderstråle, Wilhelm and Langkilde, Anna Maria and Rizi, Ehsan Parvaresh and Oldgren, Jonas and McGuire, Darren K.}},
  issn         = {{2047-9980}},
  keywords     = {{dapagliflozin; diabetes; myocardial infarction; obesity; prediabetes}},
  language     = {{eng}},
  number       = {{15}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of the American Heart Association}},
  title        = {{Impact of Dapagliflozin on Cardiometabolic Outcomes After Acute Myocardial Infarction According to Baseline Glycemic Status and Body Mass Index : Subanalyses of the DAPA-MI Trial}},
  url          = {{http://dx.doi.org/10.1161/JAHA.124.040327}},
  doi          = {{10.1161/JAHA.124.040327}},
  volume       = {{14}},
  year         = {{2025}},
}