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SGLT2 inhibition and heart failure—current concepts

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Abstract

Type 2 diabetes mellitus (T2DM) is a major risk factor for several cardiovascular (CV) conditions, including heart failure (HF). However, until recently, no therapy to treat patients with diabetes could also reduce CV risks related to HF. The EMPA-REG OUTCOME trial with empagliflozin was the first to demonstrate significant cardioprotective benefits in this population. Its impressive 35% reduction in hospitalizations for HF drew the attention of the scientific community to the possibility that pharmacologic sodium-glucose cotransporter 2 (SGLT2) inhibition could be part of the armamentarium for treating patients with HF, with and without diabetes. The recently published CANVAS Program (with canagliflozin) and real-life data from the CVD-Real Study (using dapagliflozin, empagliflozin, and canagliflozin) further strengthened this hypothesis, suggesting that the observed benefit is not restricted to a particular drug, but is rather a class effect. This review explores the effects of pharmacologic SGLT2 inhibitors’ use in cardiac function and discusses the potential role of this class of medication as a treatment for HF.

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Authors and Affiliations

  1. Department of Health Family, Medical School of Bahia, Federal University of Bahia, Praça XV de Novembro, s/n° - Largo do Terreiro de Jesus, Salvador, BA, 40026-010, Brazil

    Joaquim Silva Custodio Jr & Andre Rodrigues Duraes

  2. Post-graduate Program in Interactive Processes of Organs and Systems, Health & Science Institute, Federal University of Bahia, Salvador, BA, Brazil

    Joaquim Silva Custodio Jr

  3. Roberto Santos General Hospital – SESAB, Salvador, BA, Brazil

    Andre Rodrigues Duraes

  4. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Marconi Abreu & Natalia Albuquerque Rocha

  5. Department of Clinical Research, Federal University of Uberlandia, Uberlândia, MG, Brazil

    Leonardo Roever

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J.S. Custodio Jr. has received lecture fees from AstraZeneca, Boehringer Ingelheim, Janssen, and Eli Lilly. A.R. Duraes, M. Abreu, N. Albuquerque Rocha, and L. Roever have no conflicts of interest to disclose.

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Custodio, J.S., Duraes, A.R., Abreu, M. et al. SGLT2 inhibition and heart failure—current concepts. Heart Fail Rev 23, 409–418 (2018). https://doi.org/10.1007/s10741-018-9703-2

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