Clinical potential relevance of metabolic properties of SGLT2 inhibitors in patients with heart failure

Mattia Galli, Domenico D'Amario, Carmelo Sofia, Marcello Vaccarella, Filippo Crea, Nadia Aspromonte

Research output: Contribution to journalReview article

Abstract

Introduction: Heart failure (HF) affects approximately 2% of the population worldwide, remaining a major cause of hospitalization and mortality despite innovative therapeutic approaches introduced in the past few decades. Type 2 diabetes mellitus (T2DM) contributes significantly to end-organ damage and HF-related complications and is associated with worse clinical status and increased all-cause and cardiovascular mortality in patients with HF with reduced (HFrEF) or with preserved ejection fraction (HFpEF), compared to HF patients without T2DM. Recently, a novel class of antidiabetic drugs has been introduced: sodium glucose co-trasport-2 inhibitors (SGLT2i). Initially designed for patients with T2DM to reduce kidney blood glucose resorption, SGLT2i rapidly gained attention among HF specialists since they were able to show a beneficial prognostic impact in patients affected by HF and T2DM, even independently from the glycemic control as suggested by the EMPA-REG OUTCOME and CANVAS trials. Areas covered: The present review focuses on the mechanisms and the current clinical evidence supporting the use of SGLT2i in HF patients with T2DM. Moreover, the SGLT2i pharmacokinetic and pharmacodynamic properties will be presented in order to better understand the rationale and the design of the ongoing clinical trials investigating directly the effect of this new class of drugs in patients with HF, even independently from T2DM. Expert opinion: SGLT2i are emerging as an effective and safe therapy for the treatment of T2DM and current evidence has unexpectedly demonstrated a robust cardiovascular protection in HF patients with T2DM. Therefore, ongoing clinical trials are investigating directly the effect of this new class of drugs in patients with HF, even independently from T2DM. However, it is methodologically disappointing that the mechanisms underlying the encouraging results in cardiovascular protection of this drug class are still not fully understood. A better understanding of the pharmacokinetic and pharmacodynamic properties of SGLT2i is necessary in order to better determine the effect of this new class of drugs in patients with HF.

Original languageEnglish
Pages (from-to)1273-1285
Number of pages13
JournalExpert Opinion on Drug Metabolism and Toxicology
Volume14
Issue number12
DOIs
Publication statusPublished - Dec 2 2018

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Medical problems
Heart Failure
Type 2 Diabetes Mellitus
Sodium
Glucose
Pharmacodynamics
Pharmacokinetics
Pharmaceutical Preparations
Clinical Trials
Cardiovascular Agents
Mortality
Expert Testimony
Hypoglycemic Agents
Blood Glucose
Hospitalization
Therapeutics
Kidney

Keywords

  • dapagliflozin
  • diabetes
  • diabetes treatment
  • Empagliflozin
  • heart failure treatment
  • renal glucose transporters
  • sodium glucose co-transport-2 (SGLT2) inhibitors

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology

Cite this

Clinical potential relevance of metabolic properties of SGLT2 inhibitors in patients with heart failure. / Galli, Mattia; D'Amario, Domenico; Sofia, Carmelo; Vaccarella, Marcello; Crea, Filippo; Aspromonte, Nadia.

In: Expert Opinion on Drug Metabolism and Toxicology, Vol. 14, No. 12, 02.12.2018, p. 1273-1285.

Research output: Contribution to journalReview article

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AB - Introduction: Heart failure (HF) affects approximately 2% of the population worldwide, remaining a major cause of hospitalization and mortality despite innovative therapeutic approaches introduced in the past few decades. Type 2 diabetes mellitus (T2DM) contributes significantly to end-organ damage and HF-related complications and is associated with worse clinical status and increased all-cause and cardiovascular mortality in patients with HF with reduced (HFrEF) or with preserved ejection fraction (HFpEF), compared to HF patients without T2DM. Recently, a novel class of antidiabetic drugs has been introduced: sodium glucose co-trasport-2 inhibitors (SGLT2i). Initially designed for patients with T2DM to reduce kidney blood glucose resorption, SGLT2i rapidly gained attention among HF specialists since they were able to show a beneficial prognostic impact in patients affected by HF and T2DM, even independently from the glycemic control as suggested by the EMPA-REG OUTCOME and CANVAS trials. Areas covered: The present review focuses on the mechanisms and the current clinical evidence supporting the use of SGLT2i in HF patients with T2DM. Moreover, the SGLT2i pharmacokinetic and pharmacodynamic properties will be presented in order to better understand the rationale and the design of the ongoing clinical trials investigating directly the effect of this new class of drugs in patients with HF, even independently from T2DM. Expert opinion: SGLT2i are emerging as an effective and safe therapy for the treatment of T2DM and current evidence has unexpectedly demonstrated a robust cardiovascular protection in HF patients with T2DM. Therefore, ongoing clinical trials are investigating directly the effect of this new class of drugs in patients with HF, even independently from T2DM. However, it is methodologically disappointing that the mechanisms underlying the encouraging results in cardiovascular protection of this drug class are still not fully understood. A better understanding of the pharmacokinetic and pharmacodynamic properties of SGLT2i is necessary in order to better determine the effect of this new class of drugs in patients with HF.

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