Sodium-Glucose Cotransporter-2 Inhibitors-from the Treatment of Diabetes to Therapy of Chronic Heart Failure

Kurczyński, Dominik; Hudzik, Bartosz; Jagosz, Marta; Zabierowski, Jan; Nowak, Jolanta; Tomasik, Andrzej; Badziński, Arkadiusz; Rozentryt, Piotr; Gąsior, Mariusz

doi:10.3390/jcdd9070225

Cited by 3 publications

(5 citation statements)

References 98 publications

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“…The pleiotropic effects include blood glucose-dependent and -independent mechanisms. They affect the myocardium, blood vessels, kidneys, liver [ 109 , 110 , 111 , 112 , 113 ], and central nervous system [ 109 , 110 , 112 , 114 ].…”

Section: Sodium-glucose Cotransporter-2 (Sglt2) Inhibitorsmentioning

confidence: 99%

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The Impact of Pharmacotherapy for Heart Failure on Oxidative Stress—Role of New Drugs, Flozins

Bodnar,

Mazurkiewicz,

Chwalba

et al. 2023

Biomedicines

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Heart failure (HF) is a multifactorial clinical syndrome involving many complex processes. The causes may be related to abnormal heart structure and/or function. Changes in the renin-angiotensin-aldosterone system, the sympathetic nervous system, and the natriuretic peptide system are important in the pathophysiology of HF. Dysregulation or overexpression of these processes leads to changes in cardiac preload and afterload, changes in the vascular system, peripheral vascular dysfunction and remodeling, and endothelial dysfunction. One of the important factors responsible for the development of heart failure at the cellular level is oxidative stress. This condition leads to deleterious cellular effects as increased levels of free radicals gradually disrupt the state of equilibrium, and, as a consequence, the internal antioxidant defense system is damaged. This review focuses on pharmacotherapy for chronic heart failure with regard to oxidation–reduction metabolism, with special attention paid to the latest group of drugs, SGLT2 inhibitors—an integral part of HF treatment. These drugs have been shown to have beneficial effects by protecting the antioxidant system at the cellular level.

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Section: Sodium-glucose Cotransporter-2 (Sglt2) Inhibitorsmentioning

confidence: 99%

“…During ketosis, various organs (mainly the myocardium) take up alpha-hydroxybutyrate, thus displacing the oxidation of free fatty acids (FFA). All of these actions may result in improved myocardial metabolism and inhibition of myocardial remodeling [ 109 , 110 , 147 ].…”

Section: Sodium-glucose Cotransporter-2 (Sglt2) Inhibitorsmentioning

confidence: 99%

The Impact of Pharmacotherapy for Heart Failure on Oxidative Stress—Role of New Drugs, Flozins

Bodnar,

Mazurkiewicz,

Chwalba

et al. 2023

Biomedicines

View full text Add to dashboard Cite

show abstract

“…More recently, SGLT2 inhibitors were demonstrated to exert cardioprotective effects, although their exact mechanisms are not fully understood. Several hypotheses to explain these effects were generated, such as decreased preload and afterload due to natriuresis and reduction in blood pressure, improvement in cardiac energy metabolism and coronary endothelial function, increased cardiomyocyte autophagy and lysosomal activity, reduced oxidative stress and inflammation, and increased erythropoiesis with subsequent augmentation of the blood oxygen supply [101][102][103].…”

Section: Sodium-glucose Co-transporter-2 Inhibitorsmentioning

confidence: 99%

“…Similar results were obtained in the EMPEROR-Reduced trial, in which empagliflozin reduced the combined risk of cardiovascular death and hospitalization for HF by 25% in patients with HFrEF. Additionally, SGTL2 inhibitors appear to be more effective than vericiguat and comparable to ARNI in preventing HF hospitalization [101,106,107]. Both of these trials included more than half of the patients with an ischemic etiology of HF, and post hoc subgroup analysis showed similar outcomes in patients with or without ischemic HF [108].…”

Section: Sodium-glucose Co-transporter-2 Inhibitorsmentioning

confidence: 99%

Cardiac Reverse Remodeling in Ischemic Heart Disease with Novel Therapies for Heart Failure with Reduced Ejection Fraction

Leancă

Afrăsânie

Crișu

et al. 2023

Life

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Despite the improvements in the treatment of coronary artery disease (CAD) and acute myocardial infarction (MI) over the past 20 years, ischemic heart disease (IHD) continues to be the most common cause of heart failure (HF). In clinical trials, over 70% of patients diagnosed with HF had IHD as the underlying cause. Furthermore, IHD predicts a worse outcome for patients with HF, leading to a substantial increase in late morbidity, mortality, and healthcare costs. In recent years, new pharmacological therapies have emerged for the treatment of HF, such as sodium-glucose cotransporter-2 inhibitors, angiotensin receptor-neprilysin inhibitors, selective cardiac myosin activators, and oral soluble guanylate cyclase stimulators, demonstrating clear or potential benefits in patients with HF with reduced ejection fraction. Interventional strategies such as cardiac resynchronization therapy, cardiac contractility modulation, or baroreflex activation therapy might provide additional therapeutic benefits by improving symptoms and promoting reverse remodeling. Furthermore, cardiac regenerative therapies such as stem cell transplantation could become a new therapeutic resource in the management of HF. By analyzing the existing data from the literature, this review aims to evaluate the impact of new HF therapies in patients with IHD in order to gain further insight into the best form of therapeutic management for this large proportion of HF patients.

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“…SGLT2 inhibitors demonstrate highly beneficial and pleiotropic effects on the cardiovascular system. Even though the exact mechanism of action remains unknown, there is an increasing tendency to evaluate their use in different CV conditions [ 29 ]. In recent years, five large RCTs, which aimed was to assess the efficacy of SGLT2 inhibitors in patients with HF, were conducted, of which four assessed patients regardless of T2DM.…”

Section: Cardiovascular Outcomesmentioning

confidence: 99%

SGLT2 Inhibitors vs. GLP-1 Agonists to Treat the Heart, the Kidneys and the Brain

Rolek,

Haber,

Gajewska

et al. 2023

JCDD

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Sodium glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like-peptide-1 receptor (GLP-1-R) agonists are novel therapeutic agents used for the management of type 2 diabetes mellitus (T2DM). Recently, large-scale randomized clinical trials have been conducted to assess the cardiovascular safety of these medications. The findings of these trials have revealed that both SGLT2 inhibitors and GLP-1-R agonists exhibit favorable cardioprotective effects, including reduction in cardiovascular and all-cause mortality, a decreased risk of chronic kidney disease progression, a decrease in hospitalization for heart failure (HF), an effect shown by SGLT2 inhibitors, and stroke prevention, an effect shown by GLP-1-R agonists. Based on the results from above studies, the European and American Diabetes Associations have issued new recommendations strongly endorsing the use of SGLT2 inhibitors and GLP-1-R agonists in combination with metformin for patients with T2DM who have additional cardiovascular (CV) comorbidities or risk factors. The primary aim of this combined therapy is to prevent CV events. Although both medication groups offer beneficial effects, they demonstrate slightly different profiles. SGLT2 inhibitors have exhibited better effects regarding a reduced incidence of HF, whereas GLP-1-R agonists have shown a reduced risk of CV events, particularly stroke. Moreover, recent European Society of Cardiology as well as American College of Cardiology and American Heart Association guidelines of HF treatment stressed the importance of SGLT2 inhibitor administration in patients with HF regardless of T2DM. In this context, we present and discuss the outcomes of the most recent trials investigating the impact of SGLT2 inhibitors and GLP-1-R agonists on renal and cardiovascular outcomes in patients, both with and without T2DM. Additionally, we explore the synergistic effects of combining SGLT2 inhibitors and GLP-1-R agonists in patients with cardiovascular disease.

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Sodium-Glucose Cotransporter-2 Inhibitors-from the Treatment of Diabetes to Therapy of Chronic Heart Failure

Cited by 3 publications

References 98 publications

The Impact of Pharmacotherapy for Heart Failure on Oxidative Stress—Role of New Drugs, Flozins

The Impact of Pharmacotherapy for Heart Failure on Oxidative Stress—Role of New Drugs, Flozins

Cardiac Reverse Remodeling in Ischemic Heart Disease with Novel Therapies for Heart Failure with Reduced Ejection Fraction

SGLT2 Inhibitors vs. GLP-1 Agonists to Treat the Heart, the Kidneys and the Brain

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