Sodium–glucose co‐transporter 2 inhibitors in heart failure: beyond glycaemic control. A position paper of the Heart Failure Association of the European Society of Cardiology

Abstract

Heart failure (HF) is common and associated with a poor prognosis, despite advances in treatment. Over the last decade cardiovascular outcome trials with sodium-glucose co-transporter 2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus have demonstrated beneficial effects for three SGLT2 inhibitors (empagliflozin, canagliflozin and dapagliflozin) in reducing hospitalisations for HF. More recently, dapagliflozin reduced the risk of worsening HF or death from cardiovascular causes in patients with chronic HF with reduced left ventricular ejection fraction, with or without type 2 diabetes mellitus. A number of additional trials in HF patients with reduced and/or preserved left ventricular ejection fraction are ongoing and/or about to be reported. The present position paper summarises recent clinical trial evidence and discusses the role of SGLT2 inhibitors in the treatment of HF, pending the results of ongoing trials in different populations of patients with HF.

Heart Failure Association of the European Society of Cardiology update on sodium–glucose co‐transporter 2 inhibitors in heart failure

“…The benefit was similar in patients with or without a history of HF. These findings are consistent with those of empagliflozin, canagliflozin and dapagliflozin, described in the previous document, 1 and solidify the evidence that SGLT2 inhibitors have a beneficial effect in reducing the risk of hospitalizations for HF in patients with T2DM and CV risk factors or established CV disease.…”

“…The Heart Failure Association (HFA) of the European Society of Cardiology (ESC) has recently issued a position paper on the role of sodium–glucose co‐transporter 2 (SGLT2) inhibitors in heart failure (HF) 1 . This document was published awaiting the results of ongoing clinical trials that have since become available.…”

“…This document was published awaiting the results of ongoing clinical trials that have since become available. Hence, the present document provides an HFA update of the position paper on the role of SGTL2 inhibitors in the prevention and treatment of HF 1 in light of new evidence from clinical trials.…”

Effects of SGLT2 inhibitor dapagliflozin in patients with heart failure with reduced ejection fraction

“…В целом на сегодняшний день известно о реализации этих механизмов в сосудистые и гемодинамические, почечные, сердечные и метаболические эффекты иНГЛТ-2 (табл. 1) [15]. Таким образом, можно говорить о широком профиле влияния дапаглифлозина на СН как при наличии СД2, так и без него [16].…”

“…Результаты исследования DAPA-HF послужили основанием для регистрации 13 июля 2020г нового показания для назначения дапаглифлозина на территории Российской Федерации: "сердечная недостаточность (II-IV ФК по NYHA) со сниженной ФВ у взрослых пациентов для снижения риска сердечно-сосудистой смерти и госпитализации по поводу СН" [53]. В недавно опубликованном документе с изложением позиции экспертов Европейского общества кардиологов дапаглифлозин на сегодняшний день является единственным препаратом в своем классе, который предлагается к рассмотрению в составе базового лечения СНнФВ вне зависимости от наличия СД2 [15].…”