Minerva Endocrinologica 2020 Dec 17

DOI: 10.23736/S0391-1977.20.03221-6

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

A paradigm shift in preventing diabetic heart failure? A review of SGLT2 inhibitors

Sumanth KHADKE ¹, Hafsa JAWAID ² ✉, Farah YASMIN ³, Mashal BINTE ALI ², Abdur REHMAN ³

¹ Our lady of Fatima University, Manila, Philippines; ² Civil Hospital, Karachi Pakistan; ³ Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan

Recent trials have reported sodium-glucose co-transporter 2 (SGLT2) inhibitors to decrease cardiac morbidity and hospitalization in diabetic patients. They have a remarkable ability to modify the cardio-renal axis and have a safer metabolic profile among the existing pharmacotherapy in diabetes. There are multiple proposed mechanisms postulated behind the cardioprotection offered by these drugs as seen in CANVAS and EMPA-REG OUTCOME trial. The pathophysiological evidence which directly contributes to improved cardiac mechanics remains elusive. We aim to review all mechanisms hypothesized and present results from recent trials with new therapies. There is also evidence for a reduction in insulin resistance, inflammation, body weight and serum triglyceride levels which all contribute to improving cardiovascular outcomes in diabetes. However, evidence of adverse effects on bone metabolism and increased risk of genital and urinary tract infections limit their current use. Nonetheless, SGLT2 inhibitors with their cardioprotective effects may serve as a promising advancement in type 2 diabetes management.

KEY WORDS: CANVAS; EMPA-REG outcome; DECLARE-TIMI-58; Canagliflozin; Empagliflozin; Dapagliflozin; Adverse effects; Cardiovascular disease