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Sodium–glucose co‐transporter 2 inhibitors as an early, first‐line therapy in patients with heart failure and reduced ejection fraction
Sodium–glucose co‐transporter 2 (SGLT2) inhibitors have recently been recommended as a foundational therapy for patients with heart failure (HF) and reduced ejection fraction (HFrEF) because of their favourable effects on mortality, clinical events and quality of life. While clinical practice guidel...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley & Sons, Ltd.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9303969/ https://www.ncbi.nlm.nih.gov/pubmed/34894038 http://dx.doi.org/10.1002/ejhf.2397 |
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author | Tomasoni, Daniela Fonarow, Gregg C. Adamo, Marianna Anker, Stefan D. Butler, Javed Coats, Andrew J.S. Filippatos, Gerasimos Greene, Stephen J. McDonagh, Theresa A. Ponikowski, Piotr Rosano, Giuseppe Seferovic, Petar Vaduganathan, Muthiah Voors, Adriaan A. Metra, Marco |
author_facet | Tomasoni, Daniela Fonarow, Gregg C. Adamo, Marianna Anker, Stefan D. Butler, Javed Coats, Andrew J.S. Filippatos, Gerasimos Greene, Stephen J. McDonagh, Theresa A. Ponikowski, Piotr Rosano, Giuseppe Seferovic, Petar Vaduganathan, Muthiah Voors, Adriaan A. Metra, Marco |
author_sort | Tomasoni, Daniela |
collection | PubMed |
description | Sodium–glucose co‐transporter 2 (SGLT2) inhibitors have recently been recommended as a foundational therapy for patients with heart failure (HF) and reduced ejection fraction (HFrEF) because of their favourable effects on mortality, clinical events and quality of life. While clinical practice guidelines have recommended dapagliflozin or empagliflozin in all patients with HFrEF, or sotagliflozin in those with HFrEF and concomitant diabetes, the timing and practical integration of these drugs in clinical practice is less well defined. We propose that these drugs are candidates for early, upfront administration to patients with newly diagnosed HFrEF and for patients hospitalized with HF. Growing evidence has established early benefits, with clinically meaningful reductions in clinical events that reach statistical significance within days to weeks, following dapagliflozin, empagliflozin or, in diabetic patients, sotagliflozin initiation. Secondly, although major clinical trials have tested these drugs in patients already receiving background HF therapy, secondary analyses showed that their efficacy is independent of that. Third, SGLT2 inhibitors are generally safe and well tolerated, with clinical trial data reporting minimal effects on blood pressure, glycaemia‐related adverse events, and no excess in acute kidney injury. Rather, they exert renal protective effects and reduce risk of hyperkalaemia, properties that favour initiation, tolerance and persistence of renin–angiotensin system inhibitors and mineralocorticoid receptor antagonists. This review supports the early initiation of dapagliflozin and empagliflozin (or sotagliflozin limited to patients with diabetes) to rapidly improve clinical outcome and quality of life of HFrEF patients. |
format | Online Article Text |
id | pubmed-9303969 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley & Sons, Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-93039692022-07-28 Sodium–glucose co‐transporter 2 inhibitors as an early, first‐line therapy in patients with heart failure and reduced ejection fraction Tomasoni, Daniela Fonarow, Gregg C. Adamo, Marianna Anker, Stefan D. Butler, Javed Coats, Andrew J.S. Filippatos, Gerasimos Greene, Stephen J. McDonagh, Theresa A. Ponikowski, Piotr Rosano, Giuseppe Seferovic, Petar Vaduganathan, Muthiah Voors, Adriaan A. Metra, Marco Eur J Heart Fail Reviews Sodium–glucose co‐transporter 2 (SGLT2) inhibitors have recently been recommended as a foundational therapy for patients with heart failure (HF) and reduced ejection fraction (HFrEF) because of their favourable effects on mortality, clinical events and quality of life. While clinical practice guidelines have recommended dapagliflozin or empagliflozin in all patients with HFrEF, or sotagliflozin in those with HFrEF and concomitant diabetes, the timing and practical integration of these drugs in clinical practice is less well defined. We propose that these drugs are candidates for early, upfront administration to patients with newly diagnosed HFrEF and for patients hospitalized with HF. Growing evidence has established early benefits, with clinically meaningful reductions in clinical events that reach statistical significance within days to weeks, following dapagliflozin, empagliflozin or, in diabetic patients, sotagliflozin initiation. Secondly, although major clinical trials have tested these drugs in patients already receiving background HF therapy, secondary analyses showed that their efficacy is independent of that. Third, SGLT2 inhibitors are generally safe and well tolerated, with clinical trial data reporting minimal effects on blood pressure, glycaemia‐related adverse events, and no excess in acute kidney injury. Rather, they exert renal protective effects and reduce risk of hyperkalaemia, properties that favour initiation, tolerance and persistence of renin–angiotensin system inhibitors and mineralocorticoid receptor antagonists. This review supports the early initiation of dapagliflozin and empagliflozin (or sotagliflozin limited to patients with diabetes) to rapidly improve clinical outcome and quality of life of HFrEF patients. John Wiley & Sons, Ltd. 2022-01-17 2022-03 /pmc/articles/PMC9303969/ /pubmed/34894038 http://dx.doi.org/10.1002/ejhf.2397 Text en © 2021 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Reviews Tomasoni, Daniela Fonarow, Gregg C. Adamo, Marianna Anker, Stefan D. Butler, Javed Coats, Andrew J.S. Filippatos, Gerasimos Greene, Stephen J. McDonagh, Theresa A. Ponikowski, Piotr Rosano, Giuseppe Seferovic, Petar Vaduganathan, Muthiah Voors, Adriaan A. Metra, Marco Sodium–glucose co‐transporter 2 inhibitors as an early, first‐line therapy in patients with heart failure and reduced ejection fraction |
title | Sodium–glucose co‐transporter 2 inhibitors as an early, first‐line therapy in patients with heart failure and reduced ejection fraction |
title_full | Sodium–glucose co‐transporter 2 inhibitors as an early, first‐line therapy in patients with heart failure and reduced ejection fraction |
title_fullStr | Sodium–glucose co‐transporter 2 inhibitors as an early, first‐line therapy in patients with heart failure and reduced ejection fraction |
title_full_unstemmed | Sodium–glucose co‐transporter 2 inhibitors as an early, first‐line therapy in patients with heart failure and reduced ejection fraction |
title_short | Sodium–glucose co‐transporter 2 inhibitors as an early, first‐line therapy in patients with heart failure and reduced ejection fraction |
title_sort | sodium–glucose co‐transporter 2 inhibitors as an early, first‐line therapy in patients with heart failure and reduced ejection fraction |
topic | Reviews |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9303969/ https://www.ncbi.nlm.nih.gov/pubmed/34894038 http://dx.doi.org/10.1002/ejhf.2397 |
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