J Korean Diabetes.  2024 Mar;25(1):26-34. 10.4093/jkd.2024.25.1.26.

SGLT2 Inhibitors in the Cardiovascular Disease

• Park JJ

• KMID: 2554118
• DOI: http://doi.org/10.4093/jkd.2024.25.1.26

Abstract

Sodium glucose cotransporter 2 (SGLT2) inhibitors, initially designed for type 2 diabetes management, have exhibited consistent efficacy across the cardiovascular disease continuum. Their benefits are experienced by patients with cardiovascular risk factors, those with established atherosclerotic cardiovascular disease, and even individuals suffering from heart failure (HF). Notably, SGLT2 inhibitors have demonstrated remarkable effectiveness in preventing and managing HF, positioning them as essential primary therapies for HF patients irrespective of their diabetic status. They have emerged as a uniquely effective treatment for HF with preserved ejection fraction, filling a therapeutic gap that previously existed in this population. These cardiovascular benefits are not limited to diabetic patients, indicating a broader potential for SGLT2 inhibitors in cardiovascular care. Their expanded indications suggest a pivotal role in both the prevention and treatment of cardiovascular disease. However, while clinical outcomes with SGLT2 inhibitors are promising, the precise mechanism underlying their cardiovascular protection remains unclear. Further research is warranted to elucidate these mechanisms, potentially unveiling new therapeutic avenues and facilitating the development of novel drugs.

Keyword

Cardiovascular diseases; Diabetes mellitus; Heart failure; Sodium-glucose transporter 2 inhibitors

Figure

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  Fig. 1. Cardiovascular disease continuum and SGLT2 inhibitors clinical studies at each stage. SGLT2, sodium glucose cotransporter 2; ASCVD, atherosclerotic cardiovascular disease; CVOT, cardiovascular outcome trials; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction.

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  Fig. 2. Meta-analysis of SGLT2 inhibitors in patients with risk factors. SGLT2, sodium glucose cotransporter 2; MACE, major adverse cardiovascular event; CV, cardiovascular; HHF, hospitalization for heart failure; HR, hazard ratio; CI, confidence interval.

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  Fig. 3. Meta-analysis of SGLT2 inhibitors in patients with ASCVD. SGLT2, sodium glucose cotransporter 2; ASCVD, atherosclerotic cardiovascular disease; MACE, major adverse cardiovascular event; CV, cardiovascular; HHF, hospitalization for heart failure; HR, hazard ratio; CI, confidence interval.

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  Fig. 4. Meta-analysis of SGLT2 inhibitors in patients with heart failure. SGLT2, sodium glucose cotransporter 2; HFrEF, heart failure with reduced ejection fraction; LVEF, left ventricular ejection fraction; CVD, cardiovascular disease; HHF, hospitalization for heart failure; HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HR, hazard ratio; CI, confidence interval.

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