| Objective: Based on the conventional treatment regimen for chronic heart failure(CHF),the study was conducted to observe the lipid changes in non-diabetic CHF patients after the addition of dagliflozin and to investigate the relevant factors affecting the lipid changes.Methods: A total of 375 patients with non-diabetic CHF attending the First Affiliated Hospital of Dali University from September 2020 to December 2022 were included in a retrospective study using the physician electronic medical record management system.The patients were divided into dagliflozin group and control group according to whether dagliflozin treatment was applied or not,with 187 patients in the dagliflozin group and 188 patients in the control group.Patients in the dagliflozin group:conventional basal heart failure treatment(angiotensin II receptor-neprilysin inhibitor(ARNI)/ angiotensin receptor blockers(ARB)/Angiotensin converting enzyme inhibitors(ACEI),β-blockers,spironolactone,tab diuretics or thiazide diuretics(in the presence of edema))+ dagliflozin(10 mg/tablet,1 tablet/dose,1 time/day),control group:conventional baseline heart failure treatment.Baseline data were recorded for both groups,including general baseline information(sex,age,height,weight,body mass index(BMI),systolic blood pressure,diastolic blood pressure,heart rate,smoking history,fasting glucose,glycated serum protein,uric acid(UA),brain natriuretic peptide(BNP),low density lipoprotein-cholesterol(LDL-C),high-density lipoprotein-cholesterol(HDL-C),total cholesterol(TC),and triglycerides(TG),New York Heart Association(NYHA)classification,personal information collection(name,hospitalization number,occupation,address,contact number),underlying etiology(including ischemic cardiomyopathy,dilated cardiomyopathy(including ischemic cardiomyopathy,dilated cardiomyopathy,hypertensive heart disease),comorbidities(including atrial fibrillation,ventricular fibrillation,cerebrovascular accident,hyperuricemia,hyperthyroidism,hypothyroidism),combined medications(aspirin,statins,ARNI/ACEI/ ARB),spironolactone,tab diuretics or thiazide diuretics(in case of edema),beta-blockers,calcium channel blocker(CCB).After 3 months of continuous treatment,we observed the changes of indexes in the dagliflozin group and the control group after 3 months of treatment.Primary observation:changes in lipid levels(including TC,TG,HDL-C,LDL-C)after 3 months of treatment.Secondary indexes:Changes in cardiac function(including left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),Left ventricular end systolic diameter(LVESD),BNP),liver function(including Aspartate aminotransferase(AST),Alanine aminotransferase.(ALT),renal function(including blood urea nitrogen(BUN),serum creatinine(Cr),UA).The results of this study were statistically analyzed using SPSS26.0 software.Results: The results of statistical analysis showed that:1.There was no statistically significant difference when comparing the baseline data information of the two groups of patients(P>0.05).2.There was no statistically significant difference in TC,TG,HDL-C and LDL-C levels compared between the two groups of patients before treatment(P>0.05).There was no statistically significant difference in the corresponding lipid levels before and after treatment in the control group(P>0.05).After 3 months of treatment,TC,TG and HDL-C levels increased in the dagliflozin group compared with those before treatment,and the difference was statistically significant(P<0.05).After 3 months of treatment,TC and HDL levels were elevated in both groups compared to pre-treatment,with higher TC levels and higher HDL-C levels than in the control group,the difference was statistically significant(P<0.05),and the magnitude of changes in TG and LDL-C levels were not statistically significant compared to the control group(P>0.05).3.In the dagliflozin group,the TC level increased in 112 cases,decreased in 74 cases and remained unchanged in 1 case compared with that before the drug was administered.Baseline data such as gender,smoking history,height,weight,BMI,systolic blood pressure,diastolic blood pressure,heart rate,fasting glucose,glycated serum protein,BNP,UA,cardiac function class,left ventricular end-systolic diameter,left ventricular end-diastolic diameter,underlying etiological data,and comorbidity data were compared between the patients in the dagliflozin group and the group with decreased TC levels.The mean age of the group with increased TC level was higher than that of the group with decreased TC level,and the difference was statistically significant(P <0.01).The baseline LVEF level of the group with increased TC level was lower than that of the group with decreased TC level,and the difference was statistically significant(P <0.05).Based on this,a binary logistic regression analysis was performed with the trend of TC level change(increase or decrease)as the dependent variable and age and LVEF as the independent variables,and the results showed that age and LVEF were not independent risk factors for the trend of TC level change(increase or decrease)(P >0.05).4.In the dagliflozin group,the HDL-C level increased in 106 patients,decreased in 73 patients and remained unchanged in 8 patients compared with the pre-drug level.The baseline data of the group with elevated HDL-C levels in the dagliflozin group were compared with those of the group with reduced HDL-C levels,and the age,sex,weight,height,BMI,smoking history,systolic blood pressure,diastolic blood pressure,heart rate,fasting glucose,glycated serum protein,BNP,UA,cardiac function class,underlying etiological data,comorbidity data,and combined medication data(except β-blockers)of the patients in both groups were The differences were not statistically significant(P>0.05).LVEF levels were higher in the group with elevated HDL-C levels than in the group with reduced HDL-C levels,and the differences were statistically significant(P<0.05).The number of patients on β-blockers was higher in the group with elevated HDL-C levels than in the group with reduced HDL-C levels,and the differences were statistically significant(P<0.05).Further,binary logistic regression analysis was performed with patients’ trend of HDL-C level change(increase or decrease)as the dependent variable and history of β-blocker medication(yes or no)and LVEF as the independent variables,and the results showed that history of β-blocker medication and LVEF were not independent risk factors for trend of HDL-C level change(increase or decrease)(P > 0.05).5.After 3 months of treatment,BNP and LVESD levels decreased and LVEF levels increased in the control group compared with those before treatment,with statistically significant differences(P<0.05).After 3 months of treatment,BNP,LVEDD and LVESD levels in the dagliflozin group were lower than before treatment,and LVEF levels were higher than before treatment,with statistically significant differences(P<0.05).After 3months of treatment,LVEDD decreased in the dagliflozin group compared with the control group,and LVEF increased compared with the control group,with a statistically significant difference(P<0.05).The difference was statistically significant(P<0.05).6.After 3 months of treatment,the differences in liver function levels(including ALT,AST)and kidney function levels(including BUN,Cr,UA)in the control group were not statistically significant compared with those before treatment(P>0.05).After 3months of treatment,ALT and UA levels in the dagliflozin group improved significantly compared with those before treatment,and the difference was statistically significant(P<0.05).After 3 months of treatment,ALT levels improved significantly in the dagliflozin group compared with the control group,and UA levels improved compared with the control group,with a statistically significant(P < 0.05).Conclusion: 1.The addition of dagliflozin to conventional HF treatment in non-diabetic CHF patients for 3 months had an effect on their blood lipids.TC and HDL-C levels were elevated to some extent in non-diabetic CHF patients,but their lipid changes did not reach hyperlipidemic levels and did not reverse the effect of dagliflozin on their improved cardiac function,analyzing that the lipid changes caused by dagliflozin application in non-diabetic CHF patients in the short term may be accompanied by improved cardiac function and may have further cardiovascular benefits;2.The trend of the effect on lipids(elevated or decreased)after dagliflozin treatment was associated with age,LVEF,and beta-blocker administration,but not its independent risk factors;3.Dagliflozin treatment not only improves cardiac function(BNP,LVEF,LVEDD),but also has a protective effect on patients’ liver and kidney function,and to some extent reduces ALT and UA levels in non-diabetic CHF patients. |
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