Treatment of heart failure with preserved ejection fraction with SGLT2 inhibitors: new therapy standard?

Schneider, Christian A.; Pfister, Roman

doi:10.1007/s00059-022-05134-6

Cited by 2 publications

(5 citation statements)

References 52 publications

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“…The mechanisms underlying the beneficial effects of SGLT2i in HFpEF have yet to be completely understood. However, plausible mechanisms include reduction in arterial stiffness afterload (which in turn decreases left ventricular diastolic pressure), antiatherosclerosis, nephroprotection, reduction in left ventricular hypertrophy and inflammation, and improvement in myocardial energy production 7,18–20 . Empagliflozin is associated with improved cardiometabolic parameters, including regulation of lipid profile, antihypertensive effects, and reduction in body weight, compared with dapagliflozin 21 .…”

Section: Discussionmentioning

confidence: 99%

“…However, plausible mechanisms include reduction in arterial stiffness afterload (which in turn decreases left ventricular diastolic pressure), antiatherosclerosis, nephroprotection, reduction in left ventricular hypertrophy and inflammation, and improvement in myocardial energy production. 7,[18][19][20] Empagliflozin is associated with improved cardiometabolic parameters, including regulation of lipid profile, antihypertensive effects, and reduction in body weight, compared with dapagliflozin. 21 Empagliflozin may have superior effects in reducing inflammation, oxidative stress, and ventricular hypertrophy compared with dapagliflozin and canagliflozin.…”

Section: Ta B L E 1 (Continued)mentioning

confidence: 99%

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Comparative effectiveness of sodium‐glucose cotransporter‐2 inhibitors among patients with heart failure with preserved ejection fraction

et al. 2023

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BackgroundSodium‐glucose cotransporter‐2 inhibitors (SGLT2i) are recommended by the American Heart Association for management of heart failure with preserved ejection fraction (HFpEF), but little is known about their in‐class comparative effectiveness in real‐world settings.ObjectivesTo assess the in‐class comparative effectiveness of SGLT2i for preventing HF‐related and all‐cause hospitalizations among patients with HFpEF.MethodsUsing MarketScan® Commercial and Medicare Supplemental research databases (2012–2020), this cohort study included adults with HFpEF treated with SGLT2i. Stabilized inverse probability treatment weighted Cox proportional hazards regression was used to compare HF‐related and all‐cause hospitalizations in three pairwise comparisons: dapagliflozin versus canagliflozin, empagliflozin versus canagliflozin, and dapagliflozin versus empagliflozin. Subgroup and sensitivity analyses were conducted to assess robustness of the main analysis.ResultsIn total, 3629 SGLT2i users (881 dapagliflozin, 1120 canagliflozin, and 1628 empagliflozin) were included. Compared with canagliflozin, dapagliflozin was associated with decreased risk of HF‐related hospitalization (adjusted hazard ratio [aHR], 0.75; 95% confidence interval [CI], 0.56–1.01) and all‐cause hospitalization (aHR, 0.84; 95% CI 0.73–0.97). Compared with canagliflozin, empagliflozin was associated with 55% decreased risk of HF‐related hospitalization (aHR, 0.45; 95% CI 0.34–0.59) and 18% decreased risk of all‐cause hospitalization (aHR, 0.82; 95% CI 0.73–0.93). Compared with empagliflozin, dapagliflozin was associated with 50% increased risk of HF‐related hospitalization (aHR, 1.50; 95% CI 1.09–2.07) and a statistically nonsignificant increase in the risk of all‐cause hospitalization (aHR, 1.05; 95% CI 0.92–1.20).ConclusionsCompared with canagliflozin or dapagliflozin use, empagliflozin use was associated with decreased risk of HF‐related and all‐cause hospitalizations. Compared with canagliflozin, dapagliflozin was associated with a reduced risk of HF‐related and all‐cause hospitalizations.

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Section: Discussionmentioning

confidence: 99%

Section: Ta B L E 1 (Continued)mentioning

confidence: 99%

Comparative effectiveness of sodium‐glucose cotransporter‐2 inhibitors among patients with heart failure with preserved ejection fraction

et al. 2023

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“…The treatment landscape for heart failure has been significantly changed by the introduction of SGLT-2 inhibitors. According to data from several large clinical trials focused on patients with HFrEF, the use of different SGLT-2 inhibitors including dapagliflozin, empagliflozin and sotagliflozin significantly reduced hospitalization rates and the risk of death from cardiovascular causes [62]. The results from the Dapagliflozin in Patients with HF and reduced Ejection Fraction (DAPA-HF) trial suggest that dapagliflozin reduced the risk of urgent medical visit or hospitalization from 13.7% in the placebo group to 10% in the group of patients receiving the medication.…”

Section: Cardiovascular Benefits Of Sglt-2 Inhibitorsmentioning

confidence: 99%

“…Heart failure with preserved ejection fraction. Heart failure with preserved ejection fraction (HFpEF) is a condition characterized by left ventricular ejection fraction greater than 49% but increased left ventricular end-diastolic pressure and objective evidence of cardiac abnormalities suggestive of left ventricular diastolic dysfunction [42,49,62]. Several diseases such as coronary artery disease, rare myocardial storage diseases and hypertrophic cardiomyopathies can be associated with HFpEF and require specific diagnosis and treatment.…”

Section: Cardiovascular Benefits Of Sglt-2 Inhibitorsmentioning

confidence: 99%

“…Several diseases such as coronary artery disease, rare myocardial storage diseases and hypertrophic cardiomyopathies can be associated with HFpEF and require specific diagnosis and treatment. Along with age, arterial hypertension, obesity, and T2DM are common risk factors for the development of HFpEF [62]. The Empagliflozin in HF with a Preserved Ejection Fraction (EMPEROR-Preserved) trial published in 2021 was the first study that investigated the efficacy of SGLT-2 inhibitors in patients with HFpEF.…”

Section: Cardiovascular Benefits Of Sglt-2 Inhibitorsmentioning

confidence: 99%

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New Directions in Pharmacological Treatment With SGLT-2 Inhibitor Molecules in the Light of Current Guidelines for Diabetes Mellitus, Heart Failure and Kidney Disease

TILINCA

2023

FARMACIA

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Sodium-glucose cotransporter-2 (SGLT-2) inhibitors, a newer class of oral anti-hyperglycaemic agents, have been shown to improve cardiovascular and renal outcomes in patients with type 2 diabetes mellitus (T2DM), by reducing the risk of heart failure, cardiovascular death, and renal events. This review aimed to describe the mechanism of action and clinical benefits of SGLT-2 inhibitors, highlighting their cardiorenal protection, glucose lowering effects, and their efficacy in the management of T2DM with multiple risk factors. SGLT-2 inhibitors reduce the reabsorption of sodium and glucose from the proximal tubules, thereby increasing renal glucose and sodium excretion. In addition to their glucose-lowering property, the clinical benefits of SGLT-2 inhibitors involve weight loss and major cardio-and reno-protective effects such as decreased preload and afterload, reversed cardiac remodelling, improved endothelial function, reduced albuminuria, improved glomerular hemodynamic and preserved kidney function. Therefore, SGLT2 inhibitors are a crucial component of management guidelines for diabetes, heart failure and chronic kidney disease, even in those without T2DM. RezumatInhibitorii co-transportorului 2 de sodiu-glucoză (SGLT-2), o nouă clasă de agenți antihiperglicemianți cu administrare orală, au demonstrat îmbunătățirea rezultatelor cardiovasculare și renale la pacienți cu diabet zaharat (DZ) tip 2, prin reducerea riscului de insuficiență cardiacă, deces de origine cardiovasculară și complicații renale. Acest articol își propune descrierea mecanismului de acțiune și a beneficiilor clinice ale inhibitorilor de SGLT-2, evidențiind efectele lor protectoare cardiorenale și de scădere a glicemiei, precum și eficacitatea lor în managementul DZ tip 2 cu multipli factori de risc. Inhibitorii de SGLT-2 reduc reabsorbția sodiului și glucozei din tubii contorți proximali, crescând astfel excreția renală de glucoză și sodiu. Pe lângă scăderea glicemiei, beneficiile clinice ale inhibitorilor de SGLT-2 includ scăderea în greutate și efecte cardio-și renoprotectoare, precum scăderea presarcinii și postsarcinii cardiace, inversarea remodelării cardiace majore, îmbunătățirea funcției endoteliale, reducerea albuminuriei, ameliorarea hemodinamicii glomerulare și menținerea funcției renale. Astfel, inhibitorii de SGLT-2 reprezintă un pilon extrem de important al ghidurilor de management, atât pentru diabetul zaharat, cât și pentru insuficiența cardiacă și boala renală cronică, chiar și la cei fără DZ tip 2.

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Treatment of heart failure with preserved ejection fraction with SGLT2 inhibitors: new therapy standard?

Cited by 2 publications

References 52 publications

Comparative effectiveness of sodium‐glucose cotransporter‐2 inhibitors among patients with heart failure with preserved ejection fraction

Comparative effectiveness of sodium‐glucose cotransporter‐2 inhibitors among patients with heart failure with preserved ejection fraction

New Directions in Pharmacological Treatment With SGLT-2 Inhibitor Molecules in the Light of Current Guidelines for Diabetes Mellitus, Heart Failure and Kidney Disease

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