Utilization of SGLT-2 Inhibitors in Congestive Heart Failure Management
Congestive heart failure (CHF) is a progressive condition where the heart cannot pump blood well enough to keep up with volume demand, which results in decreased oxygen perfusion throughout the periphery and vital body organs. This condition affects over six million Americans and is projected to increase by over 46% by the year 2030. By incorporating evidence from research conducted over the past ten years, several studies demonstrate the benefits of sodium-glucose co-transporter (SGLT-2) inhibitors in managing CHF patients. The glucose-lowering medication works to relieve fluid overload by excreting excess glucose and sodium while also increasing vasodilation and reducing cardiac preload. SGLT-2 inhibitors also have an anti-inflammatory effect that decreases epicardial adipose deposition, which relieves oxidative stress on the heart. In addition to the mainstay of medical management for CHF patients, SGLT-2 inhibitors have reduced exacerbations that are often life-threatening and improved overall quality of life by reducing morbidity and mortality.
Keywords:CHF, SGLT-2 Inhibitors, Diabetes Mellitus, Fluid overload
CDC, “Heart Failure”, Centers for Disease Control and Prevention, 2023. https://www.cdc.gov/heartdisease/heart_failure.htm
A. Aimo et al., “Management of heart failure with preserved ejection fraction: From neurohormonal antagonists to Empagliflozin”, Heart Failure Reviews, vol. 28, no. 1, pp. 179-191, Jan 2023. doi:10.1007/s10741-022-10228-8.
P. A. Heidenreich et al., “2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines”, Circulation, vol. 145, no. 18, pp. e895-e1032. May 2022. doi: 10.1161/cir.0000000000001063
J. McMurray et al., “Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction”, New England Journal of Medicine, vol. 381, no. 21, pp. 1995-2008. Nov 2019. doi:10.1056/nejmoa1911303
J. T. Alexander et al., “Longer-term Benefits and Risks of Sodium-Glucose Cotransporter-2 Inhibitors in Type 2 Diabetes: A Systemic Review and Meta-analysis”, Journal of General Internal Medicine, vol. 37, no. 2, pp. 439-448. Nov 2021. doi:10.1007/s11606-021-07227-0
Center for Drug Evaluation and Research, “FDA revises labels of SGLT2 inhibitors for diabetes to include warning about too much acid in the blood and serious urinary tract infections”, U.S. Food and Drug Administration, Mar 2022. https://www.fda.gov/drugs/drug-safety-and-availability/fda-revises-labels-sglt2-inhibitors-diabetes-include-warnings-about-too-much-acid-blood-and-serious.
R. Nevola et al., “Cardiorenal impact of SGLT-2 inhibitors: A conceptual revolution in the management of type 2 diabetes, heart failure and chronic kidney disease”, Reviews in Cardiovascular Medicine, vol. 23, no. 3, pp. 106. Mar 2022. doi: 10.31083/j.rcm2302106.
B. Zinman et al., “Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes”, New England Journal of Medicine, vol. 373, no. 22, pp. 2117-2128. Nov 2015. doi:10.1056/nejmoa1504720
B. Neal et al., “Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes”, New England Journal of Medicine, vol. 377, no. 7, pp. 644-657. Aug 2017. doi:10.1056/nejmoa1611925
F. Zannad et al., “SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials”, The Lancet, vol. 396, no. 10254, pp. 819-829. Aug 2020. doi:10.1016/s0140-6736(20)31824-9
N. A. El Sayed et al., “10: Cardiovascular Disease and Risk Management”, Diabetes Care, vol. 46 no. Suppl 1, pp. S158-S190. Jan 2023. doi: 10.2337/dc23-s010.
D. Bhatt et al., “Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure”, New England Journal of Medicine, vol. 384, no. 2, pp.117-128. Jan 2021. doi:10.1056/nejmoa2030183
S. D. Solomon et al., “Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction”, New England Journal of Medicine, vol. 387, no. 12, pp. 1089-98. Sep 2022. doi: 10.1056/nejmoa2206286
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