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Published on: March 29, 2024
An update on dapagliflozin for the treatment of heart failure
1Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey. barisakincimd@gmail.com.
Insights
Sodium/glucose cotransporter 2 (SGLT2) inhibitors, like dapagliflozin, significantly reduce heart failure (HF) hospitalizations and cardiovascular death. These benefits extend to patients with and without type 2 diabetes, improving HF outcomes.
Area of Science:
- Cardiology
- Endocrinology
- Pharmacology
Background:
- Heart failure (HF) presents a significant burden of illness and mortality.
- Sodium/glucose cotransporter 2 (SGLT2) inhibitors have demonstrated cardiovascular benefits in type 2 diabetes patients.
- Dapagliflozin is approved for HF risk reduction in specific patient populations.
Purpose of the Study:
- To review heart failure (HF) outcomes from clinical trials involving SGLT2 inhibitors.
- To focus on the specific HF benefits of dapagliflozin.
- To explore potential mechanisms and safety of dapagliflozin in HF patients.
Main Methods:
- Review of large clinical trials on SGLT2 inhibitors and heart failure.
- Analysis of DAPA-HF study results for dapagliflozin.
- Examination of safety profiles and proposed mechanisms of action.
Main Results:
- Dapagliflozin significantly reduced the risk of worsening HF or cardiovascular death in NYHA class II-IV HF patients with reduced ejection fraction.
- A 30% relative risk reduction in HF hospitalizations and a 57% reduction in urgent HF visits were observed.
- An 18% relative risk reduction in cardiovascular death was also reported, irrespective of diabetes status.
Conclusions:
- Dapagliflozin offers substantial benefits for patients with heart failure with reduced ejection fraction.
- The drug's efficacy in reducing HF hospitalizations and cardiovascular death is supported by robust clinical trial data.
- Dapagliflozin is now indicated for treating HF with reduced ejection fraction in adults, with or without type 2 diabetes.
Abstract:
Heart failure (HF) is a substantial source of morbidity and mortality. Several clinical trials have reported a significant HF benefit of sodium/glucose cotransporter 2 (SGLT2) inhibitors in patients with type 2 diabetes. In 2019, the Food and Drug Administration (FDA) approved dapagliflozin to reduce hospitalization risk for HF in adults with type 2 diabetes and established cardiovascular disease or risk factors. Regardless of the presence of diabetes, the recent DAPA-HF study reported a significant relative risk (RR) reduction with dapagliflozin in the composite primary outcome of worsening HF or death from cardiovascular causes in patients with New York Heart Association (NYHA) class II, III or IV HF and an ejection fraction of 40%. There was a 30% RR reduction in hospitalizations for HF, 57% RR reduction in urgent HF visits, and 18% RR reduction in cardiovascular death. These results led the FDA to approve dapagliflozin in 2020 for the treatment of HF with reduced ejection fraction (NYHA class II-IV) in adults with and without type 2 diabetes. This article summarizes HF outcomes from large clinical trials of SGLT2 inhibitors and focuses on dapagliflozin's HF benefits. The review also covers potential mechanisms of HF benefit and the safety profile of dapagliflozin in patients with HF.
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