Improving heart failure outcomes with sodium-glucose cotransporter 2 inhibitors in different patient groups

Area of Science:

• Cardiology
• Nephrology
• Endocrinology

Background:

• Sodium-glucose cotransporter 2 inhibitors (SGLT-2is) were initially developed for type 2 diabetes management.
• Cardiovascular (CV) outcomes trials revealed unexpected benefits for heart failure (HF) beyond glycemic control.

Purpose of the Study:

• To evaluate the efficacy of SGLT-2 inhibitors in reducing HF hospitalizations and CV death.
• To assess the impact of SGLT-2 inhibitors across diverse patient populations, including those with and without type 2 diabetes and chronic kidney disease.

Main Methods:

• Analysis of data from large, randomized CV outcomes trials and subsequent SGLT-2 inhibitor trials.
• Inclusion of patients with type 2 diabetes, HF with varying ejection fractions, and chronic kidney disease with albuminuria.

Main Results:

• SGLT-2is reduced HF hospitalizations by 30% and CV death or HF hospitalization by 21% in type 2 diabetes patients.
• In HF patients (reduced, mildly reduced, or preserved ejection fraction), HF hospitalizations decreased by 28%, and CV death or HF hospitalization by 23%.
• In chronic kidney disease patients with albuminuria, SGLT-2is led to a 44% reduction in HF hospitalization and a 25% reduction in CV death or HF hospitalization.

Conclusions:

• SGLT-2 inhibitors are effective in improving HF outcomes in a broad patient spectrum.
• The benefits of SGLT-2 inhibitors in HF are observed irrespective of the presence or absence of type 2 diabetes.
• SGLT-2 inhibitors are emerging as a central therapy for HF treatment and are supported for use in patients with type 2 diabetes, CKD, and HF.