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      Sodium-Glucose co-transporter type 2 inhibitors and heart failure: a review of the state of the art

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          Abstract

          Abstract Heart Failure (HF) is a cardiovascular condition with high morbidity and mortality that conditions one of the most critical problems in public health. Despite advances in recent decades, patients continue to have major cardiovascular events and marked reduction in their quality of life. Sodium-Glucose Cotransporter Type 2 Inhibitors (SGLT2 Inhibitors) initially entered the market to treat hyperglycemia in patients with type 2 diabetes mellitus (T2DM), however the discovery of the cardiovascular benefits in patients with HF, regardless of the presence or absence of T2DM positioned it as a new pillar in clinical management. In this state-of-the-art review resulting from a comprehensive literature search (Medline, Cochrane and EMBASE), we describe the impact of SGLT2 Inhibitors on mortality and rehospitalizations in patients with HF and we propose a therapeutic plan for patients with HF to maximizes the benefits.

          Translated abstract

          Resumen La Insuficiencia Cardíaca (IC) es una condición cardiovascular con alta morbilidad y mortalidad que condiciona uno de los problemas más críticos en salud pública. A pesar de los avances en las últimas décadas, los pacientes continúan presentando eventos cardiovasculares importantes y una marcada reducción de su calidad de vida. Los inhibidores del cotransportador de sodio-glucosa tipo 2 (SGLT2) ingresaron inicialmente al mercado para tratar la hiperglucemia en pacientes con diabetes mellitus tipo 2 (DMT2), sin embargo, el descubrimiento de los beneficios cardiovasculares en pacientes con IC, independientemente de la presencia o ausencia de DMT2, lo posicionó como un nuevo pilar en manejo clínico. Esta revisión de la literatura es resultante de una búsqueda bibliográfica exhaustiva (Medline, Cochrane y EMBASE), y describimos el impacto de los iSGLT2 en la mortalidad y rehospitalizaciones en pacientes con IC y proponemos un plan terapéutico para pacientes con IC para maximizar los beneficios.

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          Most cited references51

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          2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

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            Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes.

            The effects of empagliflozin, an inhibitor of sodium-glucose cotransporter 2, in addition to standard care, on cardiovascular morbidity and mortality in patients with type 2 diabetes at high cardiovascular risk are not known.
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              Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes

              Background Canagliflozin is a sodium-glucose cotransporter 2 inhibitor that reduces glycemia as well as blood pressure, body weight, and albuminuria in people with diabetes. We report the effects of treatment with canagliflozin on cardiovascular, renal, and safety outcomes. Methods The CANVAS Program integrated data from two trials involving a total of 10,142 participants with type 2 diabetes and high cardiovascular risk. Participants in each trial were randomly assigned to receive canagliflozin or placebo and were followed for a mean of 188.2 weeks. The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. Results The mean age of the participants was 63.3 years, 35.8% were women, the mean duration of diabetes was 13.5 years, and 65.6% had a history of cardiovascular disease. The rate of the primary outcome was lower with canagliflozin than with placebo (occurring in 26.9 vs. 31.5 participants per 1000 patient-years; hazard ratio, 0.86; 95% confidence interval [CI], 0.75 to 0.97; P<0.001 for noninferiority; P=0.02 for superiority). Although on the basis of the prespecified hypothesis testing sequence the renal outcomes are not viewed as statistically significant, the results showed a possible benefit of canagliflozin with respect to the progression of albuminuria (hazard ratio, 0.73; 95% CI, 0.67 to 0.79) and the composite outcome of a sustained 40% reduction in the estimated glomerular filtration rate, the need for renal-replacement therapy, or death from renal causes (hazard ratio, 0.60; 95% CI, 0.47 to 0.77). Adverse reactions were consistent with the previously reported risks associated with canagliflozin except for an increased risk of amputation (6.3 vs. 3.4 participants per 1000 patient-years; hazard ratio, 1.97; 95% CI, 1.41 to 2.75); amputations were primarily at the level of the toe or metatarsal. Conclusions In two trials involving patients with type 2 diabetes and an elevated risk of cardiovascular disease, patients treated with canagliflozin had a lower risk of cardiovascular events than those who received placebo but a greater risk of amputation, primarily at the level of the toe or metatarsal. (Funded by Janssen Research and Development; CANVAS and CANVAS-R ClinicalTrials.gov numbers, NCT01032629 and NCT01989754 , respectively.).
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                Author and article information

                Journal
                ijm
                Iberoamerican Journal of Medicine
                Iberoam J Med
                Hospital San Pedro (Logroño, La Rioja, Spain )
                2695-5075
                2695-5075
                2023
                : 5
                : 2
                : 68-77
                Affiliations
                [2] Barranquilla Atlántico orgnameUniversidad del Norte orgdiv1Department of Internal Medicine Colombia
                [4] Milwaukee orgnameUniversity of Wisconsin orgdiv1Joseph J. Zilber School of Public Health United States
                [3] Barranquilla Atlántico orgnameUniversidad del Norte orgdiv1Department of Internal Medicine Colombia
                [1] Barranquilla Atlántico orgnameUniversidad del Norte orgdiv1Department of Internal Medicine Colombia
                Article
                S2695-50752023000200003 S2695-5075(23)00500200003
                10.53986/ibjm.2023.0009
                eca2fdc9-6ae0-4057-bd0d-a89e8e9b1c5a

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 21 November 2022
                : 10 February 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 51, Pages: 10
                Product

                SciELO Spain

                Categories
                Review

                Heart failure,SGLT2 inhibitors,Nephroprotection,Type 2 diabetes mellitus,Insuficiencia cardiaca,Inhibidores SGLT2,Nefroprotección,Diabetes mellitus tipo 2

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