Heart Failure and Metabolic Factors

  • Peter M. NilssonEmail author
  • John Molvin
  • Martin Magnusson
Part of the Updates in Hypertension and Cardiovascular Protection book series (UHCP)


The metabolic features of heart failure risk have been described in both epidemiological and pathophysiological studies. As impaired glucose metabolism and overt diabetes are closely associated with heart failure risk, the influence of antidiabetic drugs has been extensively studied in recent years. A very promising class of drugs in this respect is the sodium-glucose cotransporter 2 (SGLT2) inhibitor, now tested in large, placebo-controlled trials. Furthermore, the incretin-activating drugs have been tested for cardiovascular prevention, but so far the SGLT2 inhibitors have shown an especially more favorable effect on reducing the risk of heart failure in patients with type 2 diabetes and previous cardiovascular events.


Diabetes Glycemia Heart failure Incretin Insulin Metabolism SGLT2 



This review was supported by a grant from the Swedish Research Council and from the Heart and Lung Foundation of Sweden to PMN and grants from the Medical Faculty of Lund University Skane University Hospital, the Crafoord Foundation, the Ernhold Lundstroms Research Foundation, the Region Skane, the Hulda and Conrad Mossfelt Foundation, the Southwest Skanes Diabetes Foundation, the Kockska foundation, the Research Funds of Region Skåne and the Swedish Heart and Lung foundation and the Wallenberg Center for Molecular Medicine, Lund University to MM. Also the Knut and Alice Wallenberg foundation is acknowledged for generous support.

Conflict of Interest: PMN has received funding for educational lectures from Novo Nordisk and Boehringer Ingelheim. MM has received funding for educational lectures from Boehringer Ingelheim and Sanofi-Aventis.


  1. 1.
    Dei Cas A, Khan SS, Butler J, Mentz RJ, Bonow RO, Avogaro A, Tschoepe D, Doehner W, Greene SJ, Senni M, Gheorghiade M, Fonarow GC. Impact of diabetes on epidemiology, treatment, and outcomes of patients with heart failure. JACC Heart Fail. 2015;3(2):136–45.CrossRefGoogle Scholar
  2. 2.
    Nanayakkara S, Marwick TH, Kaye DM. The ageing heart: the systemic and coronary circulation. Heart. 2018;104(5):370–6. [Epub ahead of print] Review.CrossRefPubMedGoogle Scholar
  3. 3.
    Jordan J, Toplak H, Grassi G, Yumuk V, Kotsis V, Engeli S, Cuspidi C, Nilsson PM, Finer N, Doehner W. Joint statement of the European Association for the Study of Obesity and the European Society of Hypertension: obesity and heart failure. J Hypertens. 2016;34(9):1678–88.CrossRefGoogle Scholar
  4. 4.
    Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, Deaton C, Escaned J, Hammes HP, Huikuri H, Marre M, Marx N, Mellbin L, Ostergren J, Patrono C, Seferovic P, Uva MS, Taskinen MR, Tendera M, Tuomilehto J, Valensi P, Zamorano JL, ESC Committee for Practice Guidelines (CPG), Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Document Reviewers, De Backer G, Sirnes PA, Ezquerra EA, Avogaro A, Badimon L, Baranova E, Baumgartner H, Betteridge J, Ceriello A, Fagard R, Funck-Brentano C, Gulba DC, Hasdai D, Hoes AW, Kjekshus JK, Knuuti J, Kolh P, Lev E, Mueller C, Neyses L, Nilsson PM, Perk J, Ponikowski P, Reiner Z, Sattar N, Schächinger V, Scheen A, Schirmer H, Strömberg A, Sudzhaeva S, Tamargo JL, Viigimaa M, Vlachopoulos C, Xuereb RG. ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the task force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013;34(39):3035–87.CrossRefGoogle Scholar
  5. 5.
    Kannel WB, McGee DL. Diabetes and cardiovascular risk factors: the Framingham Study. Circulation. 1979;59:8–13.CrossRefGoogle Scholar
  6. 6.
    Bibbins-Domingo K, Lin F, Vittinghoff E, Barrett-Connor E, Hulley SB, Grady D, Shlipak MG. Predictors of heart failure among women with coronary disease. Circulation. 2004;110(11):1424–30.CrossRefGoogle Scholar
  7. 7.
    Bertoni AG, Hundley WG, Massing MW, Bonds DE, Burke GL, Goff DC Jr. Heart failure prevalence, incidence, and mortality in the elderly with diabetes. Diabetes Care. 2004;27:699–703.CrossRefGoogle Scholar
  8. 8.
    Ingelsson E, Sundström J, Arnlöv J, Zethelius B, Lind L. Insulin resistance and risk of congestive heart failure. JAMA. 2005;294(3):334–41.CrossRefGoogle Scholar
  9. 9.
    Matsushita K, Blecker S, Pazin-Filho A, Bertoni A, Chang PP, Coresh J, Selvin E. The association of hemoglobin A1c with incident heart failure among people without diabetes: the atherosclerosis risk in communities study. Diabetes. 2010;59(8):2020–6.CrossRefGoogle Scholar
  10. 10.
    Taegtmeyer H, McNulty P, Young ME. Adaptation and maladaptation of the heart in diabetes: part I: general concepts. Circulation. 2002;105:1727–33.CrossRefGoogle Scholar
  11. 11.
    Young ME, McNulty P, Taegtmeyer H. Adaptation and maladaptation of the heart in diabetes: part II: potential mechanisms. Circulation. 2002;105:1861–70.CrossRefGoogle Scholar
  12. 12.
    Thrainsdottir IS, Aspelund T, Thorgeirsson G, Gudnason V, Hardarson T, Malmberg K, Sigurdsson G, Rydén L. The association between glucose abnormalities and heart failure in the population-based Reykjavik study. Diabetes Care. 2005;28(3):612–6.CrossRefGoogle Scholar
  13. 13.
    Dauriz M, Targher G, Laroche C, Temporelli PL, Ferrari R, Anker S, Coats A, Filippatos G, Crespo-Leiro M, Mebazaa A, Piepoli MF, Maggioni AP, Tavazzi L, ESC-HFA Heart Failure Long-Term Registry. Association between diabetes and 1-year adverse clinical outcomes in a multinational cohort of ambulatory patients with chronic heart failure: results from the ESC-HFA heart failure long-term registry. Diabetes Care. 2017;40(5):671–8.CrossRefGoogle Scholar
  14. 14.
    Rosengren A, Vestberg D, Svensson AM, Kosiborod M, Clements M, Rawshani A, Pivodic A, Gudbjörnsdottir S, Lind M. Long-term excess risk of heart failure in people with type 1 diabetes: a prospective case-control study. Lancet Diabetes Endocrinol. 2015;3(11):876–85.CrossRefGoogle Scholar
  15. 15.
    Lind M, Olsson M, Rosengren A, Svensson AM, Bounias I, Gudbjörnsdottir S. The relationship between glycaemic control and heart failure in 83,021 patients with type 2 diabetes. Diabetologia. 2012;55(11):2946–53.CrossRefGoogle Scholar
  16. 16.
    Vestberg D, Rosengren A, Olsson M, Gudbjörnsdottir S, Svensson AM, Lind M. Relationship between overweight and obesity with hospitalization for heart failure in 20,985 patients with type 1 diabetes: a population-based study from the Swedish National Diabetes Registry. Diabetes Care. 2013;36(9):2857–61.CrossRefGoogle Scholar
  17. 17.
    Glogner S, Rosengren A, Olsson M, Gudbjörnsdottir S, Svensson AM, Lind M. The association between BMI and hospitalization for heart failure in 83,021 persons with type 2 diabetes: a population-based study from the Swedish National Diabetes Registry. Diabet Med. 2014;31(5):586–94.CrossRefGoogle Scholar
  18. 18.
    Leosdottir M, Willenheimer R, Plehn J, Borgquist R, Gudmundsson P, Harris TB, Launer LJ, Bjornsdottir H, Nilsson PM, Gudnason V. Myocardial structure and function by echocardiography in relation to glucometabolic status in elderly subjects from 2 population-based cohorts: a cross-sectional study. Am Heart J. 2010;159(3):414–420.e4.CrossRefGoogle Scholar
  19. 19.
    Pareek M, Nielsen ML, Gerke O, Leósdóttir M, Møller JE, Hindersson P, Sehestedt TB, Wachtell K, Nilsson PM, Olsen MH. Worsening diastolic function is associated with elevated fasting plasma glucose and increased left ventricular mass in a supra-additive fashion in an elderly, healthy, Swedish population. Int J Cardiol. 2015;184:466–72.CrossRefGoogle Scholar
  20. 20.
    Mellor KM, Bell JR, Ritchie RH, Delbridge LM. Myocardial insulin resistance, metabolic stress and autophagy in diabetes. Clin Exp Pharmacol Physiol. 2013;40(1):56–61.CrossRefGoogle Scholar
  21. 21.
    Palmieri V, Bella JN, Arnett DK, Liu JE, Oberman A, Schuck MY, Kitzman DW, Hopkins PN, Morgan D, Rao DC, Devereux RB. Effect of type 2 diabetes mellitus on left ventricular geometry and systolic function in hypertensive subjects: Hypertension Genetic Epidemiology Network (HyperGEN) study. Circulation. 2001;103:102–7.CrossRefGoogle Scholar
  22. 22.
    Santra S, Basu AK, Roychowdhury P, Banerjee R, Singhania P, Singh S, Datta UK. Comparison of left ventricular mass in normotensive type 2 diabetes mellitus patients with that in the nondiabetic population. J Cardiovasc Dis Res. 2011;2:50–6.CrossRefGoogle Scholar
  23. 23.
    Poornima IG, Parikh P, Shannon RP. Diabetic cardiomyopathy: the search for a unifying hypothesis. Circ Res. 2006;98:596–605.CrossRefGoogle Scholar
  24. 24.
    Paraskevaidis IA, Tsougos E, Panou F, Dagres N, Karatzas D, Boutati E, Varounis C, Kremastinos DT. Diastolic stress echocardiography detects coronary artery disease in patients with asymptomatic type II diabetes. Coron Artery Dis. 2010;21:104–12.CrossRefGoogle Scholar
  25. 25.
    Halse R, Pearson SL, McCormack JG, Yeaman SJ, Taylor R. Effects of tumor necrosis factor-alpha on insulin action in cultured human muscle cells. Diabetes. 2001;50:1102–9.CrossRefGoogle Scholar
  26. 26.
    Unger RH, Orci L. Lipotoxic diseases of non-adipose tissues in obesity. Int J Obes Relat Metab Disord. 2000;24(Suppl 4):S28–32.CrossRefGoogle Scholar
  27. 27.
    Zhou YT, Grayburn P, Karim A, Shimabukuro M, Higa M, Baetens D, Orci L, Unger RH. Lipotoxic heart disease in obese rats: implications for human obesity. Proc Natl Acad Sci U S A. 2000;97:1784–9.CrossRefGoogle Scholar
  28. 28.
    Bidasee KR, Nallani K, Henry B, Dincer UD, Besch HR Jr. Chronic diabetes alters function and expression of ryanodine receptor calcium-release channels in rat hearts. Mol Cell Biochem. 2003;249:113–23.CrossRefGoogle Scholar
  29. 29.
    Clark RJ, McDonough PM, Swanson E, Trost SU, Suzuki M, Fukuda M, Dillmann WH. Diabetes and the accompanying hyperglycemia impairs cardiomyocyte calcium cycling through increased nuclear O-GlcNAcylation. J Biol Chem. 2003;278:44230–7.CrossRefGoogle Scholar
  30. 30.
    Bidasee KR, Nallani K, Henry B, Dincer UD, Besch HR Jr. Chronic diabetes alters function and expression of ryanodine receptor calcium-release channels in rat hearts. Mol Cell Biochem. 2003;249(1–2):113–23.CrossRefGoogle Scholar
  31. 31.
    Clark RJ, McDonough PM, Swanson E, Trost SU, Suzuki M, Fukuda M, Dillmann WH. Diabetes and the accompanying hyperglycemia impairs cardiomyocyte calcium cycling through increased nuclear O-GlcNAcylation. J Biol Chem. 2003;278(45):44230–7.CrossRefGoogle Scholar
  32. 32.
    Holzmann M, Olsson A, Johansson J, Jensen-Urstad M. Left ventricular diastolic function is related to glucose in a middle-aged population. J Intern Med. 2002;251(5):415–20.CrossRefGoogle Scholar
  33. 33.
    Samuelsson AM, Bollano E, Mobini R, Larsson BM, Omerovic E, Fu M, Waagstein F, Holmäng A. Hyperinsulinemia: effect on cardiac mass/function, angiotensin II receptor expression, and insulin signaling pathways. Am J Physiol Heart Circ Physiol. 2006;291(2):H787–96.CrossRefGoogle Scholar
  34. 34.
    Gulati V, Harikrishnan P, Palaniswamy C, Aronow WS, Jain D, Frishman WH. Cardiac involvement in hemochromatosis. Cardiol Rev. 2014;22(2):56–68.CrossRefGoogle Scholar
  35. 35.
    van der Harst P, Voors AA, van Gilst WH, Böhm M, van Veldhuisen DJ. Statins in the treatment of chronic heart failure: a systematic review. PLoS Med. 2006;3(8):e333.CrossRefGoogle Scholar
  36. 36.
    Kjekshus J, Apetrei E, Barrios V, Böhm M, Cleland JG, Cornel JH, Dunselman P, Fonseca C, Goudev A, Grande P, Gullestad L, Hjalmarson A, Hradec J, Jánosi A, Kamenský G, Komajda M, Korewicki J, Kuusi T, Mach F, Mareev V, McMurray JJ, Ranjith N, Schaufelberger M, Vanhaecke J, van Veldhuisen DJ, Waagstein F, Wedel H, Wikstrand J, CORONA Group. Rosuvastatin in older patients with systolic heart failure. N Engl J Med. 2007;357(22):2248–61.CrossRefGoogle Scholar
  37. 37.
    Tavazzi L, Maggioni AP, Marchioli R, Barlera S, Franzosi MG, Latini R, Lucci D, Nicolosi GL, Porcu M, Tognoni G, Investigators G-HF. Effect of rosuvastatin in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet. 2008;372(9645):1231–9.CrossRefGoogle Scholar
  38. 38.
    Sharaf El Din UAA, Salem MM, Abdulazim DO. Uric acid in the pathogenesis of metabolic, renal, and cardiovascular diseases: a review. J Adv Res. 2017;8(5):537–48.CrossRefGoogle Scholar
  39. 39.
    Gupte SA. Glucose-6-phosphate dehydrogenase: a novel therapeutic target in cardiovascular diseases. Curr Opin Investig Drugs. 2008;9(9):993–1000.PubMedGoogle Scholar
  40. 40.
    Enhörning S, Hedblad B, Nilsson PM, Engström G, Melander O. Copeptin is an independent predictor of diabetic heart disease and death. Am Heart J. 2015;169(4):549–56.e1.CrossRefGoogle Scholar
  41. 41.
    Wang TJ, Larson MG, Vasan RS, Cheng S, Rhee EP, McCabe E, Lewis GD, Fox CS, Jacques PF, Fernandez C, O’Donnell CJ, Carr SA, Mootha VK, Florez JC, Souza A, Melander O, Clish CB, Gerszten RE. Metabolite profiles and the risk of developing diabetes. Nat Med. 2011;17(4):448–53.CrossRefGoogle Scholar
  42. 42.
    Magnusson M, Lewis GD, Ericson U, Orho-Melander M, Hedblad B, Engström G, Ostling G, Clish C, Wang TJ, Gerszten RE, Melander O. A diabetes-predictive amino acid score and future cardiovascular disease. Eur Heart J. 2013;34(26):1982–9.CrossRefGoogle Scholar
  43. 43.
    Cheng ML, Wang CH, Shiao MS, Liu MH, Huang YY, Huang CY, Mao CT, Lin JF, Ho HY, Yang NI. Metabolic disturbances identified in plasma are associated with outcomes in patients with heart failure: diagnostic and prognostic value of metabolomics. J Am Coll Cardiol. 2015;65(15):1509–20.CrossRefGoogle Scholar
  44. 44.
    Paulus WJ, Tschöpe C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013;62(4):263–71.CrossRefGoogle Scholar
  45. 45.
    James WP, Caterson ID, Coutinho W, Finer N, Van Gaal LF, Maggioni AP, Torp-Pedersen C, Sharma AM, Shepherd GM, Rode RA, Renz CL, Investigators S. Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. N Engl J Med. 2010;363:905–17.CrossRefGoogle Scholar
  46. 46.
    Mendes D, Alves C, Batel-Marques F. Number needed to harm in the post-marketing safety evaluation: results for rosiglitazone and pioglitazone. Pharmacoepidemiol Drug Saf. 2015;24(12):1259–70.CrossRefGoogle Scholar
  47. 47.
    Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, Mattheus M, Devins T, Johansen OE, Woerle HJ, Broedl UC, Inzucchi SE, EMPA-REG OUTCOME Investigators. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117–28.CrossRefGoogle Scholar
  48. 48.
    Neal B, Perkovic V, Mahaffey KW, de Zeeuw D, Fulcher G, Erondu N, Shaw W, Law G, Desai M, Matthews DR, CANVAS Program Collaborative Group. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377(7):644–57.CrossRefGoogle Scholar
  49. 49.
    Fitchett D, Zinman B, Wanner C, Lachin JM, Hantel S, Salsali A, Johansen OE, Woerle HJ, Broedl UC, Inzucchi SE, EMPA-REG OUTCOME® Trial Investigators. Heart failure outcomes with empagliflozin in patients with type 2 diabetes at high cardiovascular risk: results of the EMPA-REG OUTCOME® Trial. Eur Heart J. 2016;37(19):1526–34.CrossRefGoogle Scholar
  50. 50.
    Butler J, Hamo CE, Filippatos G, Pocock SJ, Bernstein RA, Brueckmann M, Cheung AK, George JT, Green JB, Januzzi JL, Kaul S, Lam CSP, Lip GYH, Marx N, McCullough PA, Mehta CR, Ponikowski P, Rosenstock J, Sattar N, Salsali A, Scirica BM, Shah SJ, Tsutsui H, Verma S, Wanner C, Woerle HJ, Zannad F, Anker SD, EMPEROR Trials Program. The potential role and rationale for treatment of heart failure with sodium-glucose co-transporter 2 inhibitors. Eur J Heart Fail. 2017;19(11):1390–400.CrossRefGoogle Scholar
  51. 51.
    Scirica BM, Bhatt DL, Braunwald E, Steg PG, Davidson J, Hirshberg B, Ohman P, Frederich R, Wiviott SD, Hoffman EB, Cavender MA, Udell JA, Desai NR, Mosenzon O, McGuire DK, Ray KK, Leiter LA, Raz I, SAVOR-TIMI 53 Steering Committee and Investigators. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med. 2013;369(14):1317–26.CrossRefGoogle Scholar
  52. 52.
    White WB, Cannon CP, Heller SR, Nissen SE, Bergenstal RM, Bakris GL, Perez AT, Fleck PR, Mehta CR, Kupfer S, Wilson C, Cushman WC, Zannad F, EXAMINE Investigators. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med. 2013;369(14):1327–35.CrossRefGoogle Scholar
  53. 53.
    Green JB, Bethel MA, Armstrong PW, Buse JB, Engel SS, Garg J, Josse R, Kaufman KD, Koglin J, Korn S, Lachin JM, McGuire DK, Pencina MJ, Standl E, Stein PP, Suryawanshi S, Van de Werf F, Peterson ED, Holman RR, TECOS Study Group. Effect of Sitagliptin on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2015;373(3):232–42.CrossRefGoogle Scholar
  54. 54.
    Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, Nauck MA, Nissen SE, Pocock S, Poulter NR, Ravn LS, Steinberg WM, Stockner M, Zinman B, Bergenstal RM, Buse JB, LEADER Steering Committee; LEADER Trial Investigators. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375(4):311–22.CrossRefGoogle Scholar
  55. 55.
    Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jódar E, Leiter LA, Lingvay I, Rosenstock J, Seufert J, Warren ML, Woo V, Hansen O, Holst AG, Pettersson J, Vilsbøll T, SUSTAIN-6 Investigators. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375(19):1834–44.CrossRefGoogle Scholar
  56. 56.
    Holman RR, Bethel MA, Mentz RJ, Thompson VP, Lokhnygina Y, Buse JB, Chan JC, Choi J, Gustavson SM, Iqbal N, Maggioni AP, Marso SP, Öhman P, Pagidipati NJ, Poulter N, Ramachandran A, Zinman B, Hernandez AF, EXSCEL Study Group. Effects of once-weekly Exenatide on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2017;377(13):1228–39.CrossRefGoogle Scholar
  57. 57.
    Margulies KB, Hernandez AF, Redfield MM, Givertz MM, Oliveira GH, Cole R, Mann DL, Whellan DJ, Kiernan MS, Felker GM, McNulty SE, Anstrom KJ, Shah MR, Braunwald E, Cappola TP, Network NHFCR. Effects of Liraglutide on clinical stability among patients with advanced heart failure and reduced ejection fraction: a randomized clinical trial. JAMA. 2016;316:500–8.CrossRefGoogle Scholar
  58. 58.
    Nilsson PM, Magnusson M. Metabolomic signatures in atherosclerotic disease: what is the potential use? Hypertens Res. 2016;39(8):576–7.CrossRefGoogle Scholar
  59. 59.
    Senthong V, Kirsop JL, Tang WH. Clinical phenotyping of heart failure with biomarkers: current and future perspectives. Curr Heart Fail Rep. 2017;14(2):106–16.CrossRefGoogle Scholar
  60. 60.
    Fitchett DH, Udell JA, Inzucchi SE. Heart failure outcomes in clinical trials of glucose-lowering agents in patients with diabetes. Eur J Heart Fail. 2017;19(1):43–53.CrossRefGoogle Scholar
  61. 61.
    Lother A, Hein L. Pharmacology of heart failure: from basic science to novel therapies. Pharmacol Ther. 2016;166:136–49.CrossRefGoogle Scholar
  62. 62.
    Tamargo M, Tamargo J. Future drug discovery in renin-angiotensin-aldosterone system intervention. Expert Opin Drug Discov. 2017;12(8):827–48.PubMedGoogle Scholar
  63. 63.
    Berbenetz NM, Mrkobrada M. Mineralocorticoid receptor antagonists for heart failure: systematic review and meta-analysis. BMC Cardiovasc Disord. 2016;16(1):246.CrossRefGoogle Scholar
  64. 64.
    Butler J, Anker SD. The ethics of conducting clinical trials with sodium-glucose Cotransporter-2 inhibitors in heart failure: is placebo assignment justified in patients with comorbid diabetes mellitus and heart failure? Circulation. 2017;136(16):1459–61. PubMed PMID: 29038205.CrossRefPubMedGoogle Scholar
  65. 65.
    Lytvyn Y, Bjornstad P, Udell JA, Lovshin JA, Cherney DZI. Sodium glucose Cotransporter-2 inhibition in heart failure: potential mechanisms, clinical applications, and summary of clinical trials. Circulation. 2017;136(17):1643–58.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Peter M. Nilsson
    • 1
    Email author
  • John Molvin
    • 2
    • 3
  • Martin Magnusson
    • 1
    • 4
    • 5
  1. 1.Department of Clinical Sciences, Skane University HospitalLund UniversityMalmöSweden
  2. 2.Department of CardiologySkane University HospitalMalmöSweden
  3. 3.Wallenberg Centre for Molecular MedicineLund UniversityLundSweden
  4. 4.Department of CardiologySkane University HospitalMalmöSweden
  5. 5.Wallenberg Centre for Molecular MedicineLund UniversityLundSweden

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