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Dapagliflozin reduces epicardial adipose tissue in patients with heart failure and type 2 diabetes.

Mohmmad Alghamdi·Adel Dihoum·Khalid Hakami·Atanu Bhattacharjee·Alexander J M Brown·Jagdeep Singh·Shaween Altalabany·Chim Lang·Ify Mordi·Faisel Khan
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Abstract

BACKGROUND: Epicardial adipose tissue (EAT) has a contributory role in the progression of heart failure. We tested whether dapagliflozin reduces EAT in adults with type 2 diabetes (T2D) and heart failure and explored links with systemic inflammation and cardiac structure. METHODS: This analysis is based on pooled data from two phase 2, single-centre, double-blind, placebo-controlled randomised trials (REFORM and DAPA-LVH) conducted in Scotland. Exactly 122 participants with T2D and stage B or C heart failure were randomised to dapagliflozin 10&#x2009;mg once daily or placebo for 12&#x2009;months. Cardiac magnetic resonance imaging (CMR) was used to assess EAT. At baseline and follow-up, the inflammatory markers TNF, IL-1, IL-6, IL-10, and CRP were measured. RESULTS: At baseline, obesity was common (75% with BMI &#x2265;30&#x2009;kg/m2) and heart-failure phenotypes were balanced (HFpEF 51%, HFrEF 49%). After 12&#x2009;months, dapagliflozin significantly reduced EAT independently of changes in BMI (-1.16&#x2009;&#xb1;&#x2009;0.18 vs. +0.36&#x2009;&#xb1;&#x2009;0.19&#x2009;cm2, p&#x2009;<&#x2009;0.001), BMI (-1.17&#x2009;&#xb1;&#x2009;0.16 vs. -0.18&#x2009;&#xb1;&#x2009;0.17&#x2009;kg/m2, p&#x2009;<&#x2009;0.001), and left ventricular mass (-3.53&#x2009;&#xb1;&#x2009;1.77 vs. +1.57&#x2009;&#xb1;&#x2009;1.83&#x2009;g, p&#x2009;=&#x2009;0.048) compared with placebo. CONCLUSION: Dapagliflozin shrinks EAT and LV mass independently of BMI in T2D patients with stage B/C heart failure, supporting EAT as a modifiable target of SGLT2 inhibition. The absence of parallel changes in systemic inflammation suggests primarily local mechanisms.

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HumansBenzhydryl CompoundsGlucosidesDiabetes Mellitus, Type 2Heart FailureMaleFemaleAdipose TissueMiddle AgedPericardiumSodium-Glucose Transporter 2 InhibitorsDouble-Blind MethodAgedMagnetic Resonance ImagingEpicardial Adipose Tissuecardiovascular diseasedapagliflozineffectivenessheart failuretype 2 diabetesJournal ArticleRandomized Controlled TrialClinical Trial, Phase II

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BibTeXRIS

Mohmmad Alghamdi, Adel Dihoum, Khalid Hakami, Atanu Bhattacharjee, Alexander J M Brown, Jagdeep Singh, Shaween Altalabany, Chim Lang, Ify Mordi, Faisel Khan. 2025-10-06. Dapagliflozin reduces epicardial adipose tissue in patients with heart failure and type 2 diabetes.. https://doi.org/10.1111/dom.70164

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