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Published on: April 8, 2013
SGLT-2 inhibitors: A step forward in the treatment of heart failure with reduced ejection fraction
José Silva-Cardoso1, Aurora Andrade2, Dulce Brito3
1Clínica de Insuficiência Cardíaca e Transplante, Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculdade de Medicina, Universidade do Porto, Porto, Portugal; CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, Porto, Portugal.
Insights
Sodium-glucose co-transporter-2 (SGLT-2) inhibitors are a new treatment for heart failure with reduced ejection fraction (HFrEF). These drugs significantly reduce hospitalizations and cardiovascular mortality in HFrEF patients.
Area of Science:
- Cardiology
- Endocrinology
- Pharmacology
Background:
- Heart failure (HF) significantly impacts morbidity, mortality, quality of life, and healthcare costs.
- Despite advancements, HF mortality and hospitalization rates remain high.
- Previous trials (EMPA-REG OUTCOME, CANVAS, DECLARE-TIMI 58, VERTIS) suggested SGLT-2 inhibitors may benefit HF patients.
Purpose of the Study:
- To review evidence supporting sodium-glucose co-transporter-2 (SGLT-2) inhibitors for treating HF with reduced ejection fraction (HFrEF).
- To establish SGLT-2 inhibitors as a novel therapeutic strategy in HFrEF management.
Main Methods:
- Review of cardiovascular safety trials in type-2 diabetes patients.
- Analysis of key clinical trial publications: DAPA-HF and EMPEROR-Reduced.
- Evaluation of SGLT-2 inhibitors' impact on HF hospitalizations and cardiovascular outcomes.
Main Results:
- Dapagliflozin (DAPA-HF) and empagliflozin (EMPEROR-Reduced) significantly reduced HF hospitalizations.
- These agents also demonstrated a reduction in cardiovascular mortality in HFrEF patients.
- Consistent findings across trials support SGLT-2 inhibitors' efficacy in HFrEF.
Conclusions:
- Sodium-glucose co-transporter-2 (SGLT-2) inhibitors are now considered a fourth pillar in HFrEF therapy.
- They offer significant prognostic benefits when added to standard HFrEF treatments.
- SGLT-2 inhibitors represent a major advancement in managing HFrEF.
Abstract:
Heart failure (HF) is a major health problem with a significant impact on morbidity, mortality, quality of life and healthcare costs. Despite the positive impact of disease-modifying therapies developed over the last four decades, HF mortality and hospitalization remain high. We aim at reviewing the evidence supporting the use of sodium-glucose co-transporter-2 (SGLT-2) inhibitors, as a novel strategy for HF with reduced ejection fraction (HFrEF) treatment. The consistent observation of a reduction in HF hospitalizations in type-2 diabetes cardiovascular safety trials EMPA-REG OUTCOME, CANVAS, DECLARE-TIMI 58 and VERTIS raised the hypothesis that SGLT-2 inhibitors could have an impact in HF treatment. This hypothesis was first confirmed in 2019 with the DAPA-HF publication showing that dapagliflozin on top of optimized HFrEF therapy, reduced HF-hospitalizations and cardiovascular mortality. This was reinforced by the EMPEROR-Reduced publication in 2020 showing that empagliflozin on top of optimized HFrEF therapy, reduced HF-hospitalizations. Both studies established SGLT-2 inhibitors as a fourth pillar of HFrEF prognosis-modifying therapy, in addition to the gold standard triple neurohormonal modulation/blockade.
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