Abstract
Sodium – glucose co-transporter 2 (SGLT2) inhibitors reduce blood glucose by inhibiting reabsorption of glucose from the proximal renal tubules. Initial studies showed that apart from reducing blood glucose they also reduce the combined endpoint of myocardial infarction, stroke, and cardiovascular death, hospitalization from heart failure, and occurrence of renal failure in patients with known cardiovascular disease or at high risk of developing cardiovascular disease. Recent studies have shown that these drugs also could be used in patients to treat heart failure or to slow the progression of renal failure, irrespective of whether the patients have diabetes or not. In this review, we discuss the clinical trial evidence for the use of SGLT2 inhibitors for the treatment of patients with heart failure with reduced ejection fraction and for the prevention of heart failure in patients with diabetes who are at high risk of cardiovascular events. We also discuss the plausible mechanisms of action for the cardiovascular beneficial effects of SGLT2 inhibitors. EMPA-REG OUTCOME TRIAL, DECLARE-TIMI 58, CANVAS, VERTIS-CV studies have shown that SGLT2 inhibitors namely empagliflozin, dapagliflozin, canagliflozin and ertugliflozin reduce the chances of hospitalisation in patients who have cardiovascular disease or at high risk of cardiovascular disease. The DAPA-HF study and the EMPEROR-REDUCED TRIAL have further shown that Dapagliflozin and Empagliflozin could be used to treat patients with heart failure, with or without diabetes. SGLT2 inhibitors provide us with a new armamentarium for treatment of patients with a triad of diabetes, heart or renal disease. Their mechanism of action in prevention or treatment of patients with heart failure however still remains speculative.
Highlights
Heart failure (HF) is a clinical syndrome consisting of typical symptoms that may be accompanied by signs caused by a structural and/or functional cardiac abnormality that results in elevated intracardiac pressures and/ or inadequate cardiac output at rest and/or during exercise
Renal dysfunction often accompanies heart failure with reduced ejection fraction and these agents may be of particular value in such a clinical scenario
Trials are underway to answer whether Sodium – glucose co-transporter 2 (SGLT2) inhibitors are useful in patients with heart failure and preserved ejection fraction
Summary
Heart failure (HF) is a clinical syndrome consisting of typical symptoms that may be accompanied by signs caused by a structural and/or functional cardiac abnormality that results in elevated intracardiac pressures and/ or inadequate cardiac output at rest and/or during exercise. The DECLARE-TIMI 58 trial [12] randomized patients with T2DM who were at risk for atherosclerotic cardiovascular disease to receive either dapagliflozin or placebo.
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Schedule a callMore From: The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology
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