SGLT-2 inhibition a useful tool in the treatment of heart failure with reduced and preserved ejection fraction
Authors:
Jiří Slíva
Authors‘ workplace:
Ústav farmakologie, 3. lékařská fakulta UK, Praha
Published in:
Vnitř Lék 2022; 68(6): 393-397
Category:
Review Articles
doi:
https://doi.org/10.36290/vnl.2022.080
Overview
Heart failure is highly prevalent in the population and, from a long-term point of view, a disease that is still difficult to treat. Although a number of medicinal solutions are offered in its treatment, there are still large reserves. The drug portfolio has recently been expanded to include the use of SGLT-2 inhibitors, initially for failure with reduced and now also with preserved ejection fraction. The question of the possibility of using these substances is discussed in the text, focusing on a possible explanation of their therapeutic benefit.
Keywords:
Ejection fraction – empagliflozin – gliflozins – heart failure – SGLT-2
Sources
1. McMurray JJV, Solomon SD, Inzucchi SE et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019 Nov 21;381(21):1995-2008.
2. Borlaug BA. The pathophysiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2014 Sep;11(9):507-15.
3. McDonagh TA, Metra M, Adamo M et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-3726.
4. Borlaug BA, Redfield MM. Diastolic and systolic heart failure are distinct phenotypes within the heart failure spectrum. Circulation. 2011 May 10;123(18):2006-13.
5. Borlaug BA. Defining HFpEF: where do we draw the line? Eur Heart J. 2016 Feb 1;37(5):463-
6. Solomon SD, Claggett B, Lewis EF et al. Influence of ejection fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved ejection fraction. Eur Heart J. 2016 Feb 1;37(5):455-62.
7. Lee DS, Gona P, Vasan RS et al. Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction: insights from the framingham heart study of the national heart, lung, and blood institute. Circulation. 2009 Jun 23;119(24):3070-7.
8. Verma S, McMurray JJV. SGLT2 inhibitors and mechanisms of cardiovascular benefit: a state‑of‑the‑art review. Diabetologia. 2018 Oct;61(10):2108-2117.
9. Marsenic O. Glucose control by the kidney: an emerging target in diabetes. Am J Kidney, DiS. 2009 May;53(5):875-83.
10. Monami M, Nardini C, Mannucci E. Efficacy and safety of sodium glucose co‑transport- 2 inhibitors in type 2 diabetes: a meta‑analysis of randomized clinical trials. Diabetes Obes Metab. 2014 May;16(5):457-66.
11. Sattar N, McLaren J, Kristensen SL et al. SGLT2 Inhibition and cardiovascular events: why did EMPA‑REG Outcomes surprise and what were the likely mechanisms? Diabetologia. 2016 Jul;59(7):1333-1339. doi: 10.1007/s00125-016-3956-x. Epub 2016 Apr 25. Erratum in: Diabetologia. 2016 Jul;59(7):1573-4.
12. Lytvyn Y, Bjornstad P, Udell JA et al. Sodium Glucose Cotransporter-2 Inhibition in Heart Failure: Potential Mechanisms, Clinical Applications, and Summary of Clinical Trials. Circulation. 2017 Oct 24;136(17):1643-1658.
13. Werner N, Nickenig G, Sinning JM. Complex PCI procedures: challenges for the interventional cardiologist. Clin Res Cardiol. 2018 Aug;107(Suppl 2):64-73.
14. Uthman L, Baartscheer A, Bleijlevens B et al. Class effects of SGLT2 inhibitors in mouse cardiomyocytes and hearts: inhibition of Na+/H+ exchanger, lowering of cytosolic Na+ and vasodilation. Diabetologia. 2018 Mar;61(3):722-726.
15. Baartscheer A, Schumacher CA, Wüst RC et al. Empagliflozin decreases myocardial cytoplasmic Na+ through inhibition of the cardiac Na+/H+ exchanger in rats and rabbits. Diabetologia. 2017 Mar;60(3):568-573.
16. Fernandes GC, Fernandes A, Cardoso R et al. Association of SGLT2 inhibitors with arrhythmias and sudden cardiac death in patients with type 2 diabetes or heart failure: A meta‑analysis of 34 randomized controlled trials. Heart Rhythm. 2021 Jul;18(7):1098-1105.
17. Packer M, Anker SD, Butler J et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med. 2020 Oct 8;383(15):1413-1424.
18. Anker SD, Butler J, Filippatos G et al. Empagliflozin in Heart Failure with a Preserved Ejection Fraction. N Engl J Med. 2021 Oct 14;385(16):1451-1461.
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Internal Medicine
2022 Issue 6
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