Six application experiences of sglt-2 inhibitors "escort" patients with heart failure

Sodium glucose cotransporter 2 (sglt-2) inhibitors help prevent heart failure in high-risk patients and slow down the progression of heart failure. According to the experience of applying such drugs to patients with heart failure, the article published in Nature Reviews cardiology gives six experience summaries:

1. Sglt-2 inhibitors mainly reduce the hospitalization rate of patients with heart failure;

2. The use of sglt-2 inhibitors is simpler than most other heart failure drugs;

3. Sglt-2 inhibitors may help reduce the risks associated with other heart failure drugs;

4. Sglt-2 inhibitors can reduce the heart failure events in patients with heart failure whose left ventricular ejection fraction (LVEF) ≤ 65%;

5. Sglt-2 inhibitors can reduce the risk of major renal adverse events in patients with heart failure with LVEF ≤ 60%;

6. Sglt-2 inhibitors may induce nutrient deprivation signals, and induce autophagy, pro survival and anti-inflammatory effects in the heart and kidney.

  

1. The main benefit of sglt-2 inhibitors is to reduce the risk of hospitalization in patients with heart failure.

In 12 large-scale clinical trials, more than 70000 patients with type 2 diabetes (without heart failure) and confirmed heart failure (50% of them do not have diabetes) were included. The study found that after long-term treatment with sglt-2 inhibitors, the risk of hospitalization due to heart failure was reduced by about 30%. Sglt-2 inhibitors have become a key component of the basic treatment of heart failure to prevent the deterioration of heart failure. 

2. Effective sglt-2 inhibitor treatment is simpler than most other drugs for heart failure.

Many heart failure drugs must start with low doses to reduce the risk of hypotension or fluid retention. In contrast, the starting dose of sglt-2 inhibitors is the target dose, and after starting treatment, it is usually not accompanied by adverse events that may lead to dose reduction or treatment interruption.

In addition, many heart failure drugs need to be taken twice a day (such as some RAAS inhibitors), but sglt-2 inhibitors only need to be taken once a day, which can significantly improve medication compliance. 

3. Concomitant use of sglt-2 inhibitors may reduce the risks associated with other drugs for the treatment of heart failure.

The initial SGLT2 inhibitor treatment usually has a diuretic effect, which may help offset β Fluid retention caused by the initiation of treatment with receptor blockers. In addition, sglt-2 inhibitors seem to help alleviate potassium retention caused by MRA.

4. Sglt-2 inhibitor has a good effect on heart failure patients with ejection fraction ≤ 65%. For heart failure patients with ejection fraction ≤ 40%, many drugs have significant efficacy, but for patients with ejection fraction ≥ 60%, the efficacy is weak. This attenuation pattern is evident in angiotensin receptor enkephalinase inhibition and MRA. Similarly, sglt-2 inhibitors showed consistent benefit in patients with ejection fraction ≤ 65%, but the effect was attenuated when the ejection fraction was higher. All the benefits of sglt-2 inhibitors, including their effects in reducing hospitalization rate of heart failure, improving health status and preventing serious adverse renal events, are gradually attenuated with the increase of ejection fraction. 

5. Sglt-2 inhibitors help to reduce the occurrence of major renal adverse events in most patients with heart failure.

Many therapeutic drugs for heart failure will aggravate azotemia during onset and follow-up, and cannot alleviate the deterioration of renal function related to heart failure. In contrast, sglt-2 inhibitors have this renal protective effect, and at least in patients with LVEF < 60%.

In addition, in patients with heart failure, the use of sglt-2 inhibitors can reduce the risk of major renal adverse events, which is similar to its benefit in patients with type 2 diabetes. 

6. There is evidence that sglt-2 inhibitors can act on the main regulatory switches in cells, inducing a state that mimics starvation, leading to the induction of nutrient deprivation signals in the whole system, accompanied by autophagy induction, pro survival and anti-inflammatory effects in the heart and kidney.

Conclusion

Regarding the efficacy and safety of sglt-2 inhibitors, relevant clinical trials have consistently shown that such drugs can play a role in the treatment of most patients with chronic heart failure. 

 

Cindy