Cardiovasc Prev Pharmacother.  2024 Oct;6(4):103-108. 10.36011/cpp.2024.6.e16.

Sodium-glucose cotransporter 2 inhibitors in cardiocerebrovascular disease

• Park JJ

• KMID: 2560381
• DOI: http://doi.org/10.36011/cpp.2024.6.e16

Abstract

Cardiovascular disease is a leading cause of global mortality, necessitating effective strategies for prevention and treatment. The cardiovascular disease continuum concept highlights the progression from risk factors such as hypertension and diabetes mellitus to advanced stages, including heart failure (HF) and death. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, initially developed to manage diabetes, have emerged as effective therapies across all stages of the cardiovascular disease continuum. Numerous cardiovascular outcome trials demonstrate that SGLT2 inhibitors significantly reduce major adverse cardiovascular events and hospitalizations for HF in patients with and without established atherosclerotic cardiovascular disease. Notably, SGLT2 inhibitors have shown remarkable benefits in reducing HF risk, even in patients without diabetes, including those with HF and preserved ejection fraction. Furthermore, recent studies in post–myocardial infarction patients suggest potential benefits in reducing hospitalizations for HF. Despite their widespread use, the precise mechanisms by which SGLT2 inhibitors confer cardiovascular protection remain unclear, suggesting the need for further investigation. In conclusion, SGLT2 inhibitors have revolutionized cardiovascular disease management, offering significant therapeutic potential across a broad spectrum of patients, and are expected to play an increasingly prominent role in both the prevention and treatment of cardiovascular disease.

Keyword

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

Figure

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  Fig. 1. The cardiovascular disease continuum, illustrating the progression from early risk factors to advanced stages of cardiovascular disease. Key sodium-glucose cotransporter 2 (SGLT2) inhibitor clinical trials are mapped to each stage, demonstrating their effects across the continuum. ASCVD, atherosclerotic cardiovascular disease; HF, heart failure; DECLARE-TIMI 58, Dapagliflozin Effect on Cardiovascular Events-Thrombolysis in Myocardial Infarction 58; CANVAS Program, Canagliflozin Cardiovascular Assessment Study Program; EMPA-REG OUTCOME, Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients-Removing Excess Glucose; VERTIS CV, Evaluation of Ertugliflozin Efficacy and Safety Cardiovascular Outcomes; DAPA-MI, Dapagliflozin in Myocardial Infarction; EMPACT-MI, Effect of Empagliflozin on Hospitalization for Heart Failure and Mortality in Patients with Acute Myocardial Infarction; HFrEF, heart failure with reduced ejection fraction; DAPA-HF, Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure; EMPEROR-Reduced, Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Reduced Ejection Fraction; HFpEF, heart failure with preserved ejection fraction; DELIVER, Dapagliflozin Evaluation to Improve the Lives of Patients with Preserved Ejection Fraction Heart Failure; EMPEROR-Preserved, Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction; SOLOIST-AHF, Sotagliflozin on Cardiovascular Events in Patients With Type 2 Diabetes Post Worsening Heart Failure.

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