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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

Robert F. Storey,J. Deanfield,S. James,R. Ajjan,N. Eriksson,D. Erlinge,M. D. de Belder,Chris P. Gale,A. Zaman,R. Hofmann,Linda G Mellbin,Kasper Andersen,Yunyun Jiang,P. A. Johansson,W. Ridderstråle,A. Langkilde,E. Parvaresh Rizi,Jonas Oldgren,Darren K. McGuire

Published 2025 in Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease

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 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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