Title:Cardio-Protective Effects of Sodium-Glucose Co-Transporter 2 Inhibitors: Focus on Heart Failure
Volume: 27
Issue: 8
Author(s): Dimos Karangelis*, C. David Mazer, Dimitrios Stakos, Aphrodite Tzifa, Spiros Loggos, Subodh Verma and Fotios Mitropoulos
Affiliation:
- Department of Cardiac Surgery, Mitera Hospital, 6 Erythrou Stavrou Street, 15123, Marousi, Athens,Greece
Keywords:
SGLT2 inhibitors, heart failure, cardiovascular events, diabetes mellitus, cardioprotective effects, antidiabetics.
Abstract:
Background: Type 2 diabetes mellitus (DM) is associated with a considerable risk of cardiovascular
and renal diseases, including heart failure. Sodium-glucose co-transporter 2 (SGLT2) inhibitors have demonstrated
unprecedented cardiorenal protective effects in large-scale clinical trials of patients with or without diabetes
and either established cardiovascular disease (CV) or multiple CV risk factors.
Objective: Herein we aim to focus on the role of SGLT2 inhibitors regarding the improvement in heart failure
outcomes and the proposed mechanisms of action by which these drugs confer their beneficial effect.
Methods: PubMed, Embase, and Google Scholar databases were searched to identify eligible articles that are
comprehensively summarized and discussed in this study.
Results: The most commonly discussed mechanisms of action are diuresis and natriuresis, reduction in preload,
afterload, and ventricular mass, as well as stimulation of erythropoietin production and improved myocardial energetics.
SGLT2 inhibitors improve outcomes in patients with established heart failure (HF) and reduce the risk
of death and HF admissions in patients with established chronic HF with reduced ejection fraction (HFrEF), either
with or without diabetes.
Conclusion: Potential key mechanisms that may explain the notable cardioprotective benefits of SGLT2 inhibitors
have been outlined. These agents have recently received class Ia recommendation in specific groups of people
with DM to lower the risk of hospitalization for HF and risk of death, while these benefits may also extend
to people without diabetes. It remains to be seen whether they will also emerge as treatment approaches in the
acute phase of CV episodes.
