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Expanded use of sodium-glucose cotransporter 2 inhibitors: Evidence beyond heart failure with reduced ejection

Erika Michelle Schoenborn1, Preston Trudell Skersick2, Claire Maxine Thrasher2

  • 1Department of Pharmacy, East Carolina University Health Medical Center, Greenville, North Carolina, USA.

Pharmacotherapy
|June 16, 2023
PubMed

Insights

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are now first-line heart failure (HF) therapy. This review details SGLT2i efficacy across HF types, mechanisms, and ongoing research for cardiovascular conditions.

Area of Science:

  • Cardiology
  • Pharmacology
  • Endocrinology

Background:

  • Sodium-glucose cotransporter 2 inhibitors (SGLT2i) initially developed for diabetes management.
  • Dapagliflozin's success in heart failure with reduced ejection fraction (HFrEF) spurred broad cardiovascular research.
  • SGLT2i now form part of first-line guideline-directed medical therapy for heart failure.

Purpose of the Study:

  • To review clinical trial data on SGLT2 inhibitors in diverse cardiovascular conditions.
  • To focus on SGLT2i efficacy in heart failure with preserved ejection fraction (HFpEF) and acute decompensated heart failure (ADHF).
  • To explore SGLT2i mechanisms, cost-effectiveness, and dual SGLT1/2 blockade.

Main Methods:

  • Comprehensive review of 14 clinical trials investigating SGLT2 inhibitors in cardiovascular disease.
  • Analysis of studies on mechanisms of action, cost-effectiveness, and dual blockade.
  • Inclusion of select ongoing trials to map the research landscape.

Main Results:

  • Multiple SGLT2 inhibitors demonstrate cardiovascular benefits, irrespective of left ventricular ejection fraction (LVEF).
  • Established efficacy in HFrEF and emerging benefits in HFpEF and ADHF.
  • Ongoing research continues to define the full scope of SGLT2i cardiovascular applications.

Conclusions:

  • SGLT2 inhibitors have become a cornerstone in heart failure management.
  • Further research is ongoing to fully elucidate SGLT2i mechanisms and expand their therapeutic role.
  • This review provides a comprehensive resource for clinicians on SGLT2i in cardiovascular care.
Keywords:
ADHFHFpEFHFrEFSGLT2iheart failure

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