Contribution of Ketone Oxidation on Energy Production in the Failing Heart
Abstract
One third of all deaths in Canada are due to cardiovascular diseases, including heart failure. Cardiovascular diseases have a considerable economic burden, and drastically impact the health and quality of life of Canadians. Heart failure (HF) is a clinical condition where the heart is unable to adequately pump blood throughout the body, limiting nutrient and 02 delivery. Individuals with type 2 diabetes (T2D) are at high risk of developing HF. A class of anti-diabetic drugs, sodium glucose co-transporter 2 inhibitors (SGLT2i), have recently been shown to improve HF outcomes in clinical trials with individuals with HF regardless of the presence of type 2 diabetes (T2D). SGLT2i are expressed in the proximal tubule of the kidney and are involved in 90% of the reabsorption of filtered glucose. SGLT2 inhibition prevents glucose reabsorption and reentry into the circulation, improving glycemic control. The EMPAREG-OUTCOMES trial in 2019 showed that the SGLT2i, empagliflozin, decreased hospitalization and deaths due to cardiovascular causes such as HF in T2D patients at high risk for cardiovascular events. The DAPA-HF trial in 2020 showed that the SGLT2i, dapagliflozin, also improved cardiac outcomes; however, in both the presence or absence of T2D. This was followed shortly after by the EMPEROR trial in 2021 which confirmed these observations with empagliflozin. However, it has not yet been fully established how exactly SGLT2i act to improve cardiac function, and the mechanisms…
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Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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