[en] Gliflozins (sodium-glucose cotransporter type 2 inhibitors or SGLT2is) are the only glucose-lowering agents that have proven their ability to reduce major cardiovascular events, hospitalisations for heart failure and the progression to end-stage kidney disease in at risk patients with type 2 diabetes (T2D). One of the most marked and reproducible effects is the reduction in hospitalisations for heart failure. This protective effect was observed in all large prospective cardiovascular outcome trials, independently of the presence of heart failure at inclusion, and was confirmed in two dedicated trials that specifically targeted patients with heart failure and reduced left ventricular ejection fraction, with or without diabetes : DAPA-HF with dapagliflozin and EMPEROR-reduced with empagliflozin. The reduction in hospitalisations for heart failure appeared more marked when baseline renal function was impaired, including when estimated glomerular filtration rate (eGFR) was inferior to 45 ml/min/1.73 m². These favourable results contribute to give a privileged position to SGLT2is in more recent international guidelines produced by diabetologists, cardiologists and nephrologists. According to these guidelines, the prescription of SGLT2is should be extended to patients with an eGFR between 30 and 60 ml/min/1.73 m² as well to non-diabetic patients with heart failure and reduced ejection fraction. For other patients with preserved ejection fraction, one has to wait for further results from ongoing large prospective trials.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Scheen, André ; Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques
Lancellotti, Patrizio ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
Language :
French
Title :
Inhibiteurs des SGLT2 : nouvelle option pour prévenir ou traiter l’insuffisance cardiaque.
Alternative titles :
[en] SGLT2 inhibitors, new option to prevent or treat heart failure
Publication date :
2021
Journal title :
Revue Médicale de Liège
ISSN :
0370-629X
eISSN :
2566-1566
Publisher :
Université de Liège. Revue Médicale de Liège, Liège, Belgium
Scheen AJ, Paquot N. Extension des indications pour les antidiabétiques avec protection cardio-rénale dans les dernières recommandations internationales pour la prise en charge du patient diabétique de type 2. Rev Med Liege 2020;75:233-9.
Scheen AJ, Paquot N. Une révolution dans le traitement du diabète de type 2: des antidiabétiques dotés d'une protection cardio-rénale indépendamment du contrôle glycémique ! Rev Med Liege 2020;75:392-8.
Scheen AJ. Sodium-glucose co-transporter type 2 inhibitors for the treatment of type 2 diabetes mellitus. Nature Rev Endocrinol 2020;16:556-77.
Scheen AJ, Delanaye P. Inhibiteurs des SGLT2 chez les patients avec insuffisance rénale chronique: des essais contrôlés aux recommandations internationales et perspectives en pratique clinique. Rev Med Liege 2021;76:186-94.
McMurray JJ, Gerstein HC, Holman RR, et al. Heart failure: a cardiovascular outcome in diabetes that can no longer be ignored. Lancet Diabetes Endocrinol 2014;2:843-51.
Ancion A, D'Orio V, Lancellotti P. Recommandations européennes concernant la prise en charge de l'insuffisance cardiaque chronique. Rev Med Liege 2017;72:68-73.
Seferovic PM, Paulus WJ. Clinical diabetic cardiomyopathy: a two-faced disease with restrictive and dilated phenotypes. Eur Heart J 2015;36:1718-27, 27a-27c.
Ancion A, Nguyen Trung ML, Tridetti J, et al. Révolution thérapeutique dans l'insuffisance cardiaque. Rev Med Liege 2020;75:304-9.
Scheen AJ. Pharmacodynamics, efficacy and safety of sodiumglucose co-transporter type 2 (SGLT2) inhibitors for the treatment of type 2 diabetes mellitus. Drugs 2015;75:33-59.
Cowie MR, Fisher M. SGLT2 inhibitors: mechanisms of cardiovascular benefit beyond glycaemic control. Nat Rev Cardiol 2020;17:761-72.
Inzucchi SE, Kosiborod M, Fitchett D, et al. Improvement in cardiovascular outcomes with empagliflozin is independent of glycemic control. Circulation 2018;138:1904-7.
Scheen AJ. Effects of reducing blood pressure on cardiovascular outcomes and mortality in patients with type 2 diabetes: focus on SGLT2 inhibitors and EMPA-REG OUTCOME. Diabetes Res Clin Pract 2016;121:204-14.
Chilton RJ. Effects of sodium-glucose cotransporter-2 inhibitors on the cardiovascular and renal complications of type 2 diabetes. Diabetes Obes Metab 2020;22:16-29.
Dutka M, Bobinski R, Ulman-Wlodarz I, et al. Sodium glucose cotransporter 2 inhibitors: mechanisms of action in heart failure. Heart Fail Rev 2020;doi: 10.1007/s10741-020-10041-1.
Scheen AJ. Protection cardio-rénale avec les inhibiteurs des SGLT2: d'EMPA-REG OUTCOME à VERTIS CV. Rev Med Suisse 2020;16:1483-8.
Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015;373:2117-28.
Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med 2017;377:644-57.
Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2019;380:347-57.
Cannon CP, Pratley R, Dagogo-Jack S, et al. Cardiovascular outcomes with ertugliflozin in type 2 diabetes. N Engl J Med 2020;383:1425-35.
Zelniker TA, Wiviott SD, Raz I, et al. SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet 2019;393:31-9.
Kosiborod M, Cavender MA, Fu AZ, et al. Lower risk of heart failure and death in patients initiated on SGLT-2 inhibitors versus other glucose-lowering drugs: the CVD-REAL study (Comparative Effectiveness of Cardiovascular Outcomes in New Users of Sodium-Glucose Cotransporter-2 Inhibitors). Circulation 2017;136:249-59.
McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med 2019;381:1995-2008.
Packer M, Anker SD, Butler J, et al. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med 2020;383:1413-24.
Bhatt DL, Szarek M, Steg PG, et al. Sotagliflozin in patients with diabetes and recent worsening heart failure. N Engl J Med 2020;384:117-28.
Zannad F, Ferreira JP, Pocock SJ, et al. SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials. Lancet 2020;396:819-29.
Butler J, Usman MS, Khan MS, et al. Efficacy and safety of SGLT2 inhibitors in heart failure: systematic review and metaanalysis. ESC Heart Failure 2020;7:3298-309.
Docherty KF, Jhund PS, Inzucchi SE, et al. Effects of dapagliflozin in DAPA-HF according to background heart failure therapy. Eur Heart J 2020;41:2379-92.
Petrie MC, Verma S, Docherty KF, et al. Effect of dapagliflozin on worsening heart failure and cardiovascular death in patients with heart failure with and without wiabetes. JAMA 2020;323:1353-68.
Anker SD, Butler J, Filippatos G, et al. Effect of empagliflozin on cardiovascular and renal outcomes in patients with heart failure by baseline diabetes status. Results from the EMPEROR-Reduced trial. Circulation 2020;143:337-49.
Cherney DZI, McGuire DK, Charbonnel B, et al. Gradient of risk and associations with cardiovascular efficacy of ertugliflozin by measures of kidney function: observations from VERTIS CV. Circulation 2021;143:602-5.
Jhund PS, Solomon SD, Docherty KF, et al. Efficacy of dapagliflozin on renal function and outcomes in patients with heart failure with reduced ejection fraction: results of DAPA-HF. Circulation 2021;143:298-309.
Zannad F, Ferreira JP, Pocock SJ, et al. Cardiac and kidney benefits of empagliflozin in heart failure across the spectrum of kidney function: insights from the EMPEROR-reduced trial. Circulation 2021;143:310-21.
Buse JB, Wexler DJ, Tsapas A, et al. 2019 update to: Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2020;63:221-8.
Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 2020;41:255-323.
Das SR, Everett BM, Birtcher KK, et al. 2020 Expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2020;76:1117-45.
Marx N, Davies MJ, Grant PJ, et al. Guideline recommendations and the positioning of newer drugs in type 2 diabetes care. Lancet Diabetes Endocrinol 2021;9:46-52.
Maddox TM, Januzzi JLJ, Allen LA, et al. 2021 Update to the 2017 ACC Expert Consensus decision pathway for optimization of heart failure treatment: answers to 10 Pivotal issues about heart failure with reduced ejection fraction: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2021;S0735-1097(20)37867-0.
Nashawi M, Sheikh O, Battisha A, et al. Beyond the myocardium? SGLT2 inhibitors target peripheral components of reduced oxygen flux in the diabetic patient with heart failure with preserved ejection fraction. Heart Fail Rev 2020; doi: 10.1007/s10741-020-09996-y.
Abraham WT, Lindenfeld J, Ponikowski P, et al. Effect of empagliflozin on exercise ability and symptoms in heart failure patients with reduced and preserved ejection fraction, with and without type 2 diabetes. Eur Heart J 2021;42:700-10.
Figtree GA, Radholm K, Barrett TD, et al. Effects of canagliflozin on heart failure outcomes associated with preserved and reduced ejection fraction in type 2 diabetes: results from the CANVAS program. Circulation 2019;139:2591-3.
Anker SD, Butler J, Filippatos GS, et al. Evaluation of the effects of sodium-glucose co-transporter 2 inhibition with empagliflozin on morbidity and mortality in patients with chronic heart failure and a preserved ejection fraction: rationale for and design of the EMPEROR-Preserved Trial. Eur J Heart Fail 2019;21:1279-87.
Williams DM, Evans M. Dapagliflozin for heart failure with preserved ejection fraction: will the DELIVER study deliver? Diabetes Ther 2020;11:2207-19.
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