Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons, Ltd. 2022
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
_version_ 1784751996119547904
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
work_keys_str_mv AT tomasonidaniela sodiumglucosecotransporter2inhibitorsasanearlyfirstlinetherapyinpatientswithheartfailureandreducedejectionfraction
AT fonarowgreggc sodiumglucosecotransporter2inhibitorsasanearlyfirstlinetherapyinpatientswithheartfailureandreducedejectionfraction
AT adamomarianna sodiumglucosecotransporter2inhibitorsasanearlyfirstlinetherapyinpatientswithheartfailureandreducedejectionfraction
AT ankerstefand sodiumglucosecotransporter2inhibitorsasanearlyfirstlinetherapyinpatientswithheartfailureandreducedejectionfraction
AT butlerjaved sodiumglucosecotransporter2inhibitorsasanearlyfirstlinetherapyinpatientswithheartfailureandreducedejectionfraction
AT coatsandrewjs sodiumglucosecotransporter2inhibitorsasanearlyfirstlinetherapyinpatientswithheartfailureandreducedejectionfraction
AT filippatosgerasimos sodiumglucosecotransporter2inhibitorsasanearlyfirstlinetherapyinpatientswithheartfailureandreducedejectionfraction
AT greenestephenj sodiumglucosecotransporter2inhibitorsasanearlyfirstlinetherapyinpatientswithheartfailureandreducedejectionfraction
AT mcdonaghtheresaa sodiumglucosecotransporter2inhibitorsasanearlyfirstlinetherapyinpatientswithheartfailureandreducedejectionfraction
AT ponikowskipiotr sodiumglucosecotransporter2inhibitorsasanearlyfirstlinetherapyinpatientswithheartfailureandreducedejectionfraction
AT rosanogiuseppe sodiumglucosecotransporter2inhibitorsasanearlyfirstlinetherapyinpatientswithheartfailureandreducedejectionfraction
AT seferovicpetar sodiumglucosecotransporter2inhibitorsasanearlyfirstlinetherapyinpatientswithheartfailureandreducedejectionfraction
AT vaduganathanmuthiah sodiumglucosecotransporter2inhibitorsasanearlyfirstlinetherapyinpatientswithheartfailureandreducedejectionfraction
AT voorsadriaana sodiumglucosecotransporter2inhibitorsasanearlyfirstlinetherapyinpatientswithheartfailureandreducedejectionfraction
AT metramarco sodiumglucosecotransporter2inhibitorsasanearlyfirstlinetherapyinpatientswithheartfailureandreducedejectionfraction