Practical Considerations and Opportunities for SGLT2 Inhibitor Prescription in Heart Failure

Faulkenberg, Kathleen D.; Williams, J. Bradley; Isaacs, Diana; West, Lucianne

doi:10.1007/s11936-020-00825-x

Cited by 4 publications

(3 citation statements)

References 36 publications

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“…When the damage occurs in the heart, the immune system activation releases a variety of inflammatory factors and activates cardiac fibroblasts leading to the abnormal collagen metabolism and myocardial necrosis and degeneration, thus causing the pathological changes such as myocardial fibrosis. Therefore, the short-term therapeutic target of heart failure alleviates the condition by improving the clinical symptoms of patients, while the long-term therapeutic target improves the survival prognosis of patients with heart failure by reversing the target organ damage such as myocardial fibrosis caused by multiple adverse factors like immune inflammatory response [ 16 , 17 ]. In this study, the levels of TNF- α , IL-1 β , IL-6, and hs-CRP in the two groups were decreased gradually after treatment, and the levels of TNF- α , IL-1 β , IL-6, and hs-CRP in the EG were obviously lower than those in the CG at week 4 of treatment ( P < 0.05).…”

Section: Discussionmentioning

confidence: 99%

Effect of Dapagliflozin on Indicators of Myocardial Fibrosis and Levels of Inflammatory Factors in Heart Failure Patients

et al. 2022

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Objective. To explore the effect of dapagliflozin on the myocardial fibrosis and the levels of inflammatory factors in heart failure patients. Methods. 60 patients with T2DM who were diagnosed as acute left heart failure or acute exacerbation of chronic left heart failure in the Department of Cardiology of our hospital from November 1, 2020, to December 31, 2021, during hospitalization were the study subjects. According to the treatment regimen, they were divided into the experimental group (EG) which received dapagliflozin and conventional drugs and the control group (CG) which received conventional drugs, with 30 cases in each group to compare and analyze the clinical indicators such as myocardial fibrosis and inflammatory factors. Results. The levels of TNF-α, IL-1β, IL-6, and hs-CRP in the two groups were decreased gradually after treatment, and the levels of TNF-α, IL-1β, IL-6, and hs-CRP in the EG were visibly lower compared with those in the CG at week 4 of treatment ( P < 0.05 ). The cardiac function evaluation of patients showed that the levels of LVEF and LVEDD in both groups were gradually improved after treatment, with a significant difference from the fourth week. In other words, compared with the CG, the LVEF level in the EG was obviously higher ( P < 0.05 ), the LVEDD level was distinctly lower ( P < 0.05 ), and the levels of ST2, BNP, and MCP-1 in the EG were clearly lower at week 4 of treatment ( P < 0.05 ) with a statistical significance in difference. Conclusion. Dapagliflozin has a definite curative effect in heart failure patients with type 2 diabetes mellitus, which can effectively reduce the inflammatory response of patients and inhibit the myocardial fibrosis, and has a potential value in improving cardiac function and promoting prognosis.

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Section: Discussionmentioning

confidence: 99%

Effect of Dapagliflozin on Indicators of Myocardial Fibrosis and Levels of Inflammatory Factors in Heart Failure Patients

et al. 2022

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“…Moreover, SGLT-2 inhibition lowers body weight, initially as a result of the diuretic effect and calorie loss, then by increased lipolysis in the adipocytes, which reduces visceral and subcutaneous body fat mass and hence obesity [15,32,77]. In addition to their anti-diabetic effect, the use of SGLT-2 inhibitors has been associated with major cardio-protective mechanisms such as reduction of myocardial stretch and cardiac preload, modest reduction of inflammatory mediators, as well as increased production and myocardial utilization of ketone bodies, which may lead to decreased oxygen demand and improvement in cardiac function [11,17,32]. On the other hand, SGLT-2 inhibitors stabilize renal function by reducing the glomerular hyperfiltration in the early stages of diabetic kidney disease, probably as a result of vasoconstriction in the renal afferent arteriole and decreased post-glomerular vascular resistance [28,45,82].…”

Section: Summarizing the Beneficial Effects Of Sglt-2 Inhibitorsmentioning

confidence: 99%

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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“…It is advisable avoid dehydration and to stop SGLT2i in acute illness and to hold it 3 days prior to scheduled surgeries to avoid such risk. 47 • Symptomatic hypotension is a notable side effect especially in HF patients taking other antifailure medications that lower BP. Careful monitoring of fluid status and dose adjustment of HF medications are essential • Canagliflozin is associated with increased risk of bone fracture as observed in CANVAS trial.…”

Section: Monitoring Risks Associated With Sglt2imentioning

confidence: 99%

Egyptian expert opinion for the use of sodium‐glucose cotransporter‐2 inhibitors in patients with heart failure with reduced ejection fraction

et al. 2022

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Sodium-glucose cotransporter-2 inhibitor (SGLT2i) in patients with type 2 diabetes reduces the risk of serious heart failure events, specifically the risk of hospitalization for heart failure, and cardiovascular death. The benefit is most apparent in patients with a heart failure with reduced ejection fraction (HFrEF). Dapagliflozin and empagliflozin reduced the risk of cardiovascular death and hospitalizations for heart failure in patients with established HFrEF, including those without diabetes. Considering the magnitude of the problem and the expected benefit on the target population, an Egyptian consensus document was conducted to demonstrate the importance of and the critical knowledge needed for effective and safe implementation of SGLT2i in the daily practice for the management of patients with HFrEF.

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Practical Considerations and Opportunities for SGLT2 Inhibitor Prescription in Heart Failure

Cited by 4 publications

References 36 publications

Effect of Dapagliflozin on Indicators of Myocardial Fibrosis and Levels of Inflammatory Factors in Heart Failure Patients

Effect of Dapagliflozin on Indicators of Myocardial Fibrosis and Levels of Inflammatory Factors in Heart Failure Patients

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

Egyptian expert opinion for the use of sodium‐glucose cotransporter‐2 inhibitors in patients with heart failure with reduced ejection fraction

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