The Role of SGLT2i in the Prevention and Treatment of Heart Failure

Diabetes mellitus (DM) is an important independent risk factor for incident heart failure (HF). DM is also a prominent prognostic factor for major cardiovascular (CV) adverse events in patients with established HF with reduced (HFrEF) or preserved ejection fraction (HFpEF). Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are recently approved drugs for DM treatment. SGLT2i lead to natriuresis and glycosuria with subsequent reductions in blood glucose, intravascular volume, and blood pressure. SGLT2i demonstrated a remarkable relative risk reduction in hospitalization for heart failure in large CV outcome trials of patients with DM. In addition, there was a more modest but also a relevant reduction in CV mortality with empagliflozin. SGLT2i reduce recurrent myocardial infarctions in patients with prior myocardial infarction. SGLT2i were subsequently evaluated in patients with HFrEF, including those without DM. Dapagliflozin was associated with reductions in the primary composite endpoint of worsening heart failure or CV death and each component separately. Considering their remarkable CV benefits and nephroprotection, SGLT2i represent invaluable therapy for the primary and secondary prevention of heart diseases in patients with DM or HFrEF. Ongoing trials may confirm the potential impact of SGTL2i in patients with HFpEF and acutely decompensating HF.

Keywords: Diabetes Mellitus, Heart Failure, SGLT2 Inhibitors.