Modification of the of the cardiometabolic profile using combined therapy of the angiotensin receptor-neprilysin inhibitor and empagliflozin in comorbid patients with Chronic Heart Failure and type 2 Diabetes Mellitus

Abstract

Chronic heart failure (CHF) and type 2 diabetes mellitus (DM2) and very common comorbidities with bidirectional, mutually aggravating courses. DM2 is known as an independent risk factor of cardiovascular complications whereas a higher CHF functional class is associated with increased risk of DM2. At present time, hypoglycemic drugs of the gliflozin class and the angiotensin receptor-neprilysin inhibitor (ARNI) are widely discussed in connection with their use in the treatment of patients with CHF and DM. The PARADIGM-HF study investigated effects of long-term treatment of CHF with reduced ejection fraction with presently the only representative of the ARNI class, a single supramolecular complex of valsartan-sacubitril. This medicine has already exceled enalapril at the effect not only on the incidence of nonfatal and fatal cardiovascular events but also on general mortality. Mean age of patients included into that study was 63.8±11.5 years; 21 % of them were females. In real-life clinical practice, physicians more frequently see older patients, and most of them are females, particularly with DM2. On the other hand, sodium-glucose cotransporter-2 inhibitors, including empagliflozin, significantly decreased the death rate and the frequency of CHF exacerbations in patients with DM2 and concomitant cardiovascular diseases, including CHF. This article describes a clinical case of initiating the valsartan-sacubitril treatment in combination with empagliflozin in an elderly female patient with congestive CHF with intermediate ejection fraction (EF) and comorbidities, including a history of myocardial infarction and DM2. Of interest is the rapid positive dynamics of clinical, laboratory (NT-proBNP) and instrumental (echocardiography) markers of CHF. At 3 months, the EF “recovered” from intermediate to preserved during the use of a comprehensive cardio-reno-metabolic approach. Both cardiologists and endocrinologists should definitely consider this approach in managing such patients since current cardiological drugs have additional pleiotropic metabolic effects whereas hypoglycemic drugs, in their turn, influence the cardiological prognosis.

Phenotypic clusters in heart failure with preserved and mid-range ejection fraction: new data and perspectives

“…Мы наблюдали процесс "восстановления" ФВ ЛЖ с 42% до 51% у коморбидной пациентки с ХСНпФВ и СД 2 спустя 3 мес. терапии в рамках терапевтической стратегии комплексной кардио-ренометаболической протекции, включающей, наряду с бета-адре-ноблокаторами и АМКР, АРНИ и ИНГЛТ-2, что послужило стимулом к сохранению приверженности подобранной терапии для пациентки, а также мотивом для тиражирования подобной практики у мультидисциплинарной команды лечащих врачей [11].…”

“…К примеру, в уже процитированном выше исследовании PARAGON-HF, где изучалось влияние АРНИ на течение ХСН с ФВ ЛЖ ≥45%, индекс массы тела (ИМТ) участников составлял 30,2±4,9 кг/м 2 , при этом доля пациентов с СД 2 типа достигла 43% [16]. Учитывая антигипергликемические эффекты АРНИ [11], а также результаты исследований АРНИ и ИНГЛТ-2 у пациентов с СД 2 типа и ХСНнФВ [17], кажутся оправданными надежды медицинской общественности на благоприятное влияние ИНГЛТ-2 (в т.ч. в сочетании с АРНИ) на клиническое течение и прогноз у пациентов с ХСНпФВ и ХСНсФВ в продолжающихся в настоящее время исследованиях.…”