SGLT2 Inhibitor: an Emerging Pillar in Heart Failure Therapeutics?

Abstract

Heart failure (HF) is a worldwide pandemic that affects at least 26 million people and is becoming more prevalent. Heart failure health expenditures are substantial and will considerably increase with population aging. Newer medications for treating type 2 diabetes include sodium-glucose cotransporter-2 inhibitors (SGLT2). Recent clinical studies and research have shown the efficacy of this class in treating heart failure by lowering the risk of cardiovascular events, hospitalization, and mortality. In addition, there is undeniable evidence that SGLT2 inhibitors have a beneficial effect on metabolic function, even though the mechanisms responsible for these drugs' practical consequences have not been completely elucidated. In this narrative review, we discuss the effects of SGLT2 inhibitors on the provision of cardiac energy by ketone bodies, pathological remodeling of the ventricle, arterial stiffness, and inflammation in patients with HF.

FIGURE 1.

Evolution of the treatment of Heart Failure with reduced ejection fraction. (ACEi=angiotensin-converting enzyme inhibitor; ICD=implantable cardiacdefibrillator; CRT=cardiac resynchronization therapy; VAD=long-term ventricular assist device; ARNi=angiotensin receptorneprilysin inhibitor; sGC=soluble guanylate cyclase)

TABLE 2.

The development of clinical trials about SGLT2 inhibitors

FIGURE 3.

Cardiometabolic effects of SGLT2 inhibitors