Shedding light on the effects of sodium-glucose cotransporter 2 inhibitors in the early stages of heart failure
Abstract
Heart failure (HF), which falls outside of the historical macrovascular or microvascular categorizations of diabetes complications, has been overlooked for long time in diabetic patients, despite its increasing prevalence and mortality. As originally stated in the Framingham studies, diabetes is associated with an increased risk of HF. Subsequent studies not only corroborated these findings but also identified HF as the most frequent first onset of cardiovascular involvement. The paramount role of proper management of common modifiable risk factors such as hypertension, obesity, dyslipidemia and smoking, became rapidly clear. Conversely, the impact of intensive glycemic control was more contentious. A large meta-analysis of randomized controlled trials reported a lack of effect of strict glycemic control as compared to standard care on HF-related outcomes. The considerable heterogeneity of the effect estimate and the higher risk conferred by thiazolidinediones suggested that mechanism of action of antidiabetic drugs played a key role. Furthermore, the safety concerns of pioglitazone led Food and Drug Administration to release a guidance for drug manufacturers stating that cardiovascular risk should be comprehensively evaluated during drug development. Surprisingly, in just a few years, large cardiovascular outcome trials established the beneficial cardiovascular effects of sodium-glucose cotransporter 2 inhibitors. These effects were consistent regardless diabetes and…
How strong is the evidence?
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.
Read the paper
Related studies
- Strategy for Mitigating DKA Risk in Patients with Type 1 Diabetes on Adjunctive Treatment with SGLT Inhibitors: A STICH Protocol
- Glucoraphanin: a broccoli sprout extract that ameliorates obesity-induced inflammation and insulin resistance
- SGLT2 Inhibitors in Heart Failure: Targeted Metabolomics and Energetic Metabolism
- Mechanisms of blood pressure reduction with sodium-glucose co-transporter 2 (SGLT2) inhibitors
- Sodium-glucose cotransporter inhibitors: beyond glycaemic control
- Decoding the effects of SGLT2 inhibitors on cardiac arrhythmias in heart failure
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.