Sodium Glucose Co-Transporter-2 (SGLT 2) Inhibitor as A Therapy For Heart Failure With Low Ejection Fraction (HFrEF)

Muhammad Gilang Dwi Putra, Sidhi Laksono

Abstract


Heart failure is a major cause of cardiovascular morbidity and mortality worldwide despite advances in prevention and management. Recent clinical trial findings have shown that sodium-glucose co-transporter 2 inhibitor (SGLT2i) produces effects other than lowering blood glucose levels, i.e., exhibits beneficial cardiovascular effects. The purpose of this paper is to determine the role of SGLT2i in heart failure patients with low ejection fraction (HFrEF) so that it can be used as a guide for future management. This study is a narrative review by searching on Google Scholar through several keywords. The period including articles obtained is articles from 2014 to 2022. The diuretic effect of SGLT2i can cause an increase in cardiac preload. The reduction in cardiac afterload likely occurs through a decrease in blood pressure and arterial stiffness resulting in increased endocardial blood flow. SGLT2i has a beneficial effect on the heart remodeling process. SGLT2i can prevent heart failure by increasing the production of ATP from the oxidation of ketone bodiesSGLT2i in heart failure patients can reduce blood pressure, maintain a decrease in eGFR and reduce the risk of acute kidney injury (AKI) in patients. SGLT2i is very effective in the treatment of HFrEF patients. Because of these advantages, further research is needed in Indonesia in order to determine the effectiveness and impact of giving SGLT2i to HFrEF patients in Indonesia.


Keywords


SGLT2 inhibitors; Heart Failure; Therapy

References


Baartscheer, A., Schumacher, C. A., Wüst, R. C. I., Fiolet, J. W. T., Stienen, G. J. M., Coronel, R., & Zuurbier, C. J. (2017). Empagliflozin decreases myocardial cytoplasmic Na + through inhibition of the cardiac Na +/H + exchanger in rats and rabbits. Diabetologia, 60(3), 568573. https://doi.org/10.1007/S00125-016-4134-X

Bassi, N. S., Ziaeian, B., Yancy, C. W., & Fonarow, G. C. (2020). Association of Optimal Implementation of Sodium-Glucose Cotransporter 2 Inhibitor Therapy With Outcome for Patients With Heart Failure. JAMA Cardiology, 5(8), 948951. https://doi.org/10.1001/JAMACARDIO.2020.0898

Damman, K., Valente, M. A. E., Voors, A. A., OConnor, C. M., van Veldhuisen, D. J., & Hillege, H. L. (2014). Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. European Heart Journal, 35(7), 455469. https://doi.org/10.1093/EURHEARTJ/EHT386

Garvey, W. T., van Gaal, L., Leiter, L. A., Vijapurkar, U., List, J., Cuddihy, R., Ren, J., & Davies, M. J. (2018). Effects of canagliflozin versus glimepiride on adipokines and inflammatory biomarkers in type 2 diabetes. Metabolism: Clinical and Experimental, 85, 3237. https://doi.org/10.1016/J.METABOL.2018.02.002

Hajouli, S., & Ludhwani, D. (2022). Heart Failure And Ejection Fraction. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK553115/

Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., Fang, J. C., Fedson, S. E., Fonarow, G. C., Hayek, S. S., Hernandez, A. F., Khazanie, P., Kittleson, M. M., Lee, C. S., Link, M. S., Yancy, C. W. (2022). 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(18), E895E1032. https://doi.org/10.1161/CIR.0000000000001063

Indonesian Central Bureau of Statistics. (2020). 2020 Elderly Population Statistics (Statistik Penduduk Lanjut Usia 2020).

Januzzi, J. L., Butler, J., Jarolim, P., Sattar, N., Vijapurkar, U., Desai, M., & Davies, M. J. (2017). Effects of Canagliflozin on Cardiovascular Biomarkers in Older Adults With Type 2 Diabetes. Journal of the American College of Cardiology, 70(6), 704712. https://doi.org/10.1016/J.JACC.2017.06.016

Kang, S., Verma, S., Teng, G., Belke, D. D., Svystonyuk, D. A., Guzzardi, D. G., Park, D. S., Turnbull, J. D., Dundas, J. A., & Fedak, P. W. (2017). Abstract 15925: Empagliflozin Attenuates Extracellular Matrix Remodeling by Human Cardiac Fibroblasts: Novel Translational Clues to EMPA-REG OUTCOME. Circulation, 136(suppl_1), A15925A15925. https://doi.org/10.1161/circ.136.suppl_1.15925

Laksono S, Pratama A, Halomoan R, Andra CA. (2022). A Short Review of New Drugs for Heart Failure: Omecamtiv Mecarbil and Vericiguat. JDDT, 12(2-S), 206-9. https://jddtonline.info/index.php/jddt/article/view/5432

Laksono S, Nurapipah P, Nurusshofa Z, Rininta R. (2022). Role of Primary Care in Management of Heart Failure Preserved Ejection Fraction (HFpEF): A Literature Review. JDDT, 12(3-S), 221-4. https://jddtonline.info/index.php/jddt/article/view/5508

Lytvyn, Y., Bjornstad, P., Udell, J. A., Lovshin, J. A., & Cherney, D. Z. I. (2017). Sodium Glucose Cotransporter-2 Inhibition in Heart Failure: Potential Mechanisms, Clinical Applications, and Summary of Clinical Trials. Circulation, 136(17), 16431658. https://doi.org/10.1161/CIRCULATIONAHA.117.030012

Mazidi, M., Rezaie, P., Gao, H. K., & Kengne, A. P. (2017). Effect of Sodium-Glucose Cotransport-2 Inhibitors on Blood Pressure in People With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of 43 Randomized Control Trials With 22 528 Patients. Journal of the American Heart Association, 6(6). https://doi.org/10.1161/JAHA.116.004007

McDonagh, T. A. , Metra, M. , Adamo, M. , Gardner, R. S. , Baumbach, A. , Bhm, M. , Burri, H. , Butler, J. , ÄŒelutkienÄ—, J. , Chioncel, O. , Cleland, J. , Coats, A. , Crespo-Leiro M. G., Farmakis, D. , Gilard, M. , Heymans, S. , Hoes, A. W. , Jaarsma, T. , Jankowska, E. A. , & Lainscak, M. ,. (2021). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 42(36), 35993726. https://doi.org/10.1093/EURHEARTJ/EHAB368

McEwan, P., Darlington, O., McMurray, J. J. V., Jhund, P. S., Docherty, K. F., Bhm, M., Petrie, M. C., Bergenheim, K., & Qin, L. (2020). Cost-effectiveness of dapagliflozin as a treatment for heart failure with reduced ejection fraction: a multinational health-economic analysis of DAPA-HF. European Journal of Heart Failure, 22(11), 21472156. https://doi.org/10.1002/EJHF.1978

McMurray, J. J. V., DeMets, D. L., Inzucchi, S. E., Køber, L., Kosiborod, M. N., Langkilde, A. M., Martinez, F. A., Bengtsson, O., Ponikowski, P., Sabatine, M. S., Sjstrand, M., & Solomon, S. D. (2019). The Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure (DAPA-HF) trial: baseline characteristics. European Journal of Heart Failure, 21(11), 14021411. https://doi.org/10.1002/EJHF.1548

Packer, M. (2018). Do sodium-glucose co-transporter-2 inhibitors prevent heart failure with a preserved ejection fraction by counterbalancing the effects of leptin? A novel hypothesis. Diabetes, Obesity & Metabolism, 20(6), 13611366. https://doi.org/10.1111/DOM.13229

Packer, M., Anker, S. D., Butler, J., Filippatos, G., Ferreira, J. P., Pocock, S. J., Sattar, N., Brueckmann, M., Jamal, W., Cotton, D., Iwata, T., & Zannad, F. (2021). Empagliflozin in Patients With Heart Failure, Reduced Ejection Fraction, and Volume Overload: EMPEROR-Reduced Trial. Journal of the American College of Cardiology, 77(11), 13811392. https://doi.org/10.1016/J.JACC.2021.01.033

Packer, M., Anker, S. D., Butler, J., Filippatos, G., & Zannad, F. (2017). Effects of Sodium-Glucose Cotransporter 2 Inhibitors for the Treatment of Patients With Heart Failure: Proposal of a Novel Mechanism of Action. JAMA Cardiology, 2(9), 10251029. https://doi.org/10.1001/JAMACARDIO.2017.2275

Rukmini R, Handajani A, Paramita A, Andarwati P, & Laksono AD. (2022). Non-Communicable Diseases among the Elderly in Indonesia in 2018. Indian Journal of Forensic Medicine & Toxicology, 16(1). https://doi.org/10.37506/IJFMT.V16I1.17631

Santos-Gallego, C. G., Requena-Ibanez, J. A., San Antonio, R., Ishikawa, K., Watanabe, S., Picatoste, B., Flores, E., Garcia-Ropero, A., Sanz, J., Hajjar, R. J., Fuster, V., & Badimon, J. J. (2019). Empagliflozin Ameliorates Adverse Left Ventricular Remodeling in Nondiabetic Heart Failure by Enhancing Myocardial Energetics. Journal of the American College of Cardiology, 73(15), 19311944. https://doi.org/10.1016/J.JACC.2019.01.056

Tomasoni, D., Fonarow, G. C., Adamo, M., Anker, S. D., Butler, J., Coats, A. J. S., Filippatos, G., Greene, S. J., McDonagh, T. A., Ponikowski, P., Rosano, G., Seferovic, P., Vaduganathan, M., Voors, A. A., & Metra, M. (2022). Sodium-glucose co-transporter 2 inhibitors as an early, first-line therapy in patients with heart failure and reduced ejection fraction. European Journal of Heart Failure, 24(3), 431441. https://doi.org/10.1002/EJHF.2397

Tromp, J., Ponikowski, P., Salsali, A., Angermann, C. E., Biegus, J., Blatchford, J., Collins, S. P., Ferreira, J. P., Grauer, C., Kosiborod, M., Nassif, M. E., Psotka, M. A., Brueckmann, M., Teerlink, J. R., & Voors, A. A. (2021). Sodiumglucose coâ€transporter 2 inhibition in patients hospitalized for acute decompensated heart failure: rationale for and design of the EMPULSE trial. European Journal of Heart Failure, 23(5), 826. https://doi.org/10.1002/EJHF.2137

Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Alonso, A., Beaton, A. Z., Bittencourt, M. S., Boehme, A. K., Buxton, A. E., Carson, A. P., Commodore-Mensah, Y., Elkind, M. S. V., Evenson, K. R., Eze-Nliam, C., Ferguson, J. F., Generoso, G., Ho, J. E., Kalani, R., Khan, S. S., Kissela, B. M., Martin, S. S. (2022). Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation, 145(8), e153e639. https://doi.org/10.1161/CIR.0000000000001052

Vaduganathan, M., Claggett, B. L., Jhund, P. S., Cunningham, J. W., Pedro Ferreira, J., Zannad, F., Packer, M., Fonarow, G. C., McMurray, J. J. V., & Solomon, S. D. (2020). Estimating lifetime benefits of comprehensive disease-modifying pharmacological therapies in patients with heart failure with reduced ejection fraction: a comparative analysis of three randomised controlled trials. Lancet (London, England), 396(10244), 121128. https://doi.org/10.1016/S0140-6736(20)30748-0

Verma, S. (2019). Potential Mechanisms of Sodium-Glucose Co-Transporter 2 Inhibitor-Related Cardiovascular Benefits. The American Journal of Cardiology, 124 Suppl 1, S36S44. https://doi.org/10.1016/J.AMJCARD.2019.10.028

Verma, S., Rawat, S., Ho, K. L., Wagg, C. S., Zhang, L., Teoh, H., Dyck, J. E., Uddin, G. M., Oudit, G. Y., Mayoux, E., Lehrke, M., Marx, N., & Lopaschuk, G. D. (2018). Empagliflozin Increases Cardiac Energy Production in Diabetes: Novel Translational Insights Into the Heart Failure Benefits of SGLT2 Inhibitors. JACC. Basic to Translational Science, 3(5), 575587. https://doi.org/10.1016/J.JACBTS.2018.07.006

Vukadinović, D., Abdin, A., Anker, S. D., Rosano, G. M., Mahfoud, F., Packer, M., Butler, J., & Bhm, M. (2022). Side effects and treatment initiation barriers of SGLT2 inhibitors in heart failure: A systematic review and meta-analysis. European Journal of Heart Failure. https://doi.org/10.1002/EJHF.2584


Full Text: PDF

DOI: 10.33751/jf.v12i2.5767 Abstract views : 165 views : 96

Refbacks

  • There are currently no refbacks.