Two Tales: One Story
Abstract
lthough the sodium-glucose cotransporter-2 (SGLT2) inhibitors were originally developed to manage hyperglycemia in people with type 2 diabetes, they have consistently been found to improve heart failure and kidney outcomes.In contrast to the initial SGLT2 inhibitor outcome trials that demonstrated robust reductions for incident heart failure in people with type 2 diabetes, 2 recent trials-EMPEROR-Reduced (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Reduced Ejection Fraction; with empagliflozin) 1 and DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure; with dapagliflozin) 2,3 -have examined the efficacy of SGLT2 inhibitors to treat patients with heart failure with reduced ejection fraction (HFrEF), with or without type 2 diabetes.We compare the 2 trials and their results.Although both EMPEROR-Reduced (n=3730) 1 and DAPA-HF (n=4744) 2 enrolled patients with chronic heart failure and a left ventricular ejection fraction of ≤40%, they differed with respect to their NT-proBNP (N-terminal pro-B-type natriuretic peptide) eligibility criteria (Table ), with the former requiring a sliding scale NT-proB-NP level according to baseline left ventricular ejection fraction.Such a strategy, by design, was used with an intent to target patients with more advanced HFrEF.Indeed, the baseline left ventricular ejection fraction was lower (27% versus 31%) and the median NT-proBNP levels higher (≈1900 pg/mL versus ≈1430 pg/mL) in EM-PEROR-Reduced…
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