Abstract

Introduction: Angina with non-obstructive coronary arteries (ANOCA) affects four million individuals in the U.S. and is associated with an economic burden that exceeds obstructive coronary artery disease (CAD). Sodium Glucose Cotransporter-2 Inhibitors (SGLT2i) are a novel class of glucose control medications initially indicated for use in type 2 diabetes that also reduce the risk major adverse cardiovascular events (MACE) in cardiovascular diseases. SGLT2i have recently been found to reduce the risk of MACE in patients with heart failure with preserved ejection fraction (HFpEF), which shares a common pathophysiological mechanism (coronary microvascular dysfunction) to ANOCA. Here, we examined the effects of SGLT2i on symptoms in ANOCA patients. Methods: Utilizing the Women’s Heart Center (WHC) Registry, we conducted a retrospective chart review of ANOCA patients who previously underwent coronary functional testing (CFT), were prescribed SGL2i, and were assessed for follow-up within 6 months. All brands of SGLT2i (dapagliflozin and empagliflozin) were included and symptoms were assessed utilizing validated questionnaires (NYHA HF and CCS angina class) pre- and post-treatment. Results: Among 34 ANOCA patients who underwent CFT and were clinically treated with SGLT2i’s, 29 (88%) were female (mean age=60.2; SD=11.4) and median treatment duration was 276 days (IQR:151,531). At the time of CFT, 50% had diabetes, 68% had hypertension, 97% had dyslipidemia, and 26% had a history of obstructive CAD. Among ANOCA patients, there were significantly fewer patients reporting angina at CCS class of 3 or 4 (moderate or severe limitation) post SGLT2i treatment (McNemar’s Exact, p=0.039, Figure 1). Among ANOCA patients with contaminant HFpEF (N=15, 53%), there were significantly fewer patients reporting a functional impairment at NYHA class of III and IV (marked or severe limitation) post SGLT2i treatment (McNemar’s Exact, p=0.016). Conclusions: SGLT2i show potential for reducing angina in ANOCA patients and improving function in patients with both ANOCA and HFpEF. Together, these data suggest benefit of SGLT2i in ANOCA patients and future studies should examine the effect these drugs have on underlying mechanisms (CMD).