Diabetes mellitus and heart failure: the role of SGLT2 inhibitors
Authors:
Jindřich Špinar 1; Jiří Vítovec 2; Lenka Špinarová 2
Authors‘ workplace:
Interní kardiologická klinika LF MU a FN Brno, pracoviště Bohunice
1; 1. interní kardioangiologická klinika LF MU a FN U sv. Anny v Brně
2
Published in:
AtheroRev 2018; 3(1): 40-45
Category:
Reviews
Inhibitory SGLT2 – glifloziny byly do klinické praxe uvedeny jako perorální antidiabetika, která působí mechanizmem zvýšeného vylučování glukózy močí pomocí blokády kotransportéru SGLT2, čímž je zabráněno zpětnému vstřebání glukózy v ledvinách. První velká ukončená klinická studie EMPA REG outcome prokázala ale nejen efekt na diabetes mellitus, ale i efekt na snížení kardiovaskulárních příhod, především na snížení hospitalizací a mortality pro srdeční selhání.
Overview
SGLT2 inhibitors – gliflozins were introduced into clinical practice as peroral antidiabetics, acting by increased glucose excretion by urine using the blockade of SGLT2 co transporter, which leads to blockade of glucose reabsorption in kidneys. The first big clinical trial EMPA REG outcome has shown not only the effect on diabetes mellitus but also the effect on decrease of cardiovascular events, especially Heart failure mortality and hospitalizations. A decrease in body weight by 2–3 and a decrease of systolic blood pressure by 3–5 mmHg kg were also new information. The CANVAS trials were presented in 2017 and confirmed this beneficial effect to decrease of hospitalization from heart failure and other CV events. Data form real life – CVD REAL research on more than 300 000 patient all over the world and confirm positive results from clinical trials.
Key words:
dapagliflozin, diabetes mellitus, empagliflozin, heart failure, SGLT2
Received:
10. 12. 2017
Accepted:
25. 1. 2018
Sources
1. Ambrosy AP, Gheorghiade M, Chioncel O et al. Global perspectives in hospitalized heart failure: regional and ethnic variation in patient characeteristics, management and outcomes. Curr Heart Fail Rep 2014; 11(4): 416–427. Dostupné z DOI: <http://doi: 10.1007/s11897–014–0221–9>.
2. Braunwald E. The war against heart failure. Lancet 2015; 385(9970): 812–824. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(14)61889–4>.
3. Cook C, Cole G, Asaria P et al. The annual global economic burden of heart failure. Int J Cardiol 2014; 171(3): 368–378. Dostupné z DOI: <http://dx.doi.org/10.1016/j.ijcard.2013.12.028>.
4. Fabiánová J. Kardiovaskulární účinky dapagliflozinu u pacientů s diabetes mellitus 2. typu a různou úrovní rizika. Farmakoterapie 2016; 12(1): 172–175.
5. Ferrannini E, Muscelli E, Frascerra S et al. Metabolic response to sodium- glucose contransporter 2 inhibition in type 2 diabetic patients. J Clin Invest 2014; 124(2): 499–508. Dostupné z DOI: <http://dx.doi.org/10.1172/JCI72227>. Erratum in J Clin Invest 2014; 124(4): 1868.
6. Fioretto P, Giaccari A, Sesti G. Efficacy and safety of dapagliflozin, a sodium glucose cotransporter 2 (SGLT2) inhibitor, in diabetes mellitus. Cardiovasc Diabetol 2015; 14: 142. Dostupné z DOI: <http://dx.doi.org/10.1186/s12933–015–0297-x>.
7. Fioretto P, Stefansson BV, Johnsson EK et al. Dapagliflozin reduces albuminuria over 2 years in diabetic patients with renal impairment. J Am Soc Nephrol 2015; 26:1A. Abstr. TH-OR001.
8. Goto A, Arah OA, Goto M et al. Severe hypoglycaemia and cardiovascular disease: systematic review and meta-analysis with bias analysis. Br Med J 2013; 347: f4533. Dostupné z DOI: <http://dx.doi.org/10.1136/bmj.f4533>.
9. Hummel CS, Lu C, Loo DD et al. Glucose transport by human renal Na+/D-glucose cotransporters SGLT1 SGLT2. Am J Physiol Cell Physiol 2011; 300(1): C14-C21. Dostupné z DOI: <http://dx.doi.org/10.1152/ajpcell.00388.2010>. Erratum in Am J Physiol Cell Physiol 2011; 300(3) :C721.
10. Khaw KT, Wareham N, Bingham S et al. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med 2004; 141(6): 413–420.
11. Kosiborod M, Cavender MA, Fu AZ et al. [CVD-REAL Investigators and Study Group]. Lower Risk of Heart Failure and Death in Patients Initiated on SGLT-2 Inhibitors Versus Other Glucose-Lowering Drugs. Circulation 2017; 117: A029190. Dostupné z DOI: <https://doi.org/10.1161/CIRCULATIONAHA.117.029190>.
12. Kvapil M. EMPA REG OUTCOME Důkaz, že populace pacientů s diabetem se měni. Remedia 2016; 26(1): 67–72.
13. Langkilde AM, Johansson P. Ptaszynska A et al. Cardiovascular safety of the SGLT2 inhibitor dapagliflozin: meta-analysis with > 6000 patient-years exposure. 2013 AHA Scientific Sessions, Abstr. 11105.
14. McGill JB. The SGLT2 Inhibitor Empagliflozin for the Treatment of Type 2 Diabetes Mellitus: a Bench to Bedside Review. Diabetes Ther 2014; 5(1): 43–63. Dostupné z DOI: <http://dx.doi.org/10.1007/s13300–014–0063–1>.
15. Ponikowski P, Voors AA, Anker SD et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37(27): 2129–2200. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehw128>. Erratum in Erratum. [Eur Heart J. 2016].
16. Prázný M, Šoupal J. Postavení nových antidiabetik v klinické praxi: SGLT2 vs DPP4 inhibitory. Vnitř Lék 2015; 61(4): 291–294.
17. Sattar N, Petrie MC, Zinnad B et al. Novel Diabetes Drugs and the Cardiovascular Specialist. J Am Coll Cardiol 2017; 69(21): 2646–2656. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2017.04.014>.
18. Sonesson C, Johansson PA, Johnsson E et al. Cardiovascular effects of dapagliflozin in patients with type 2 diabetes and different risk categories: a meta-analysis. Cardiovasc Diabetol 2016; 15: 37. Dostupné z DOI: <http://dx.doi.org/10.1186/s12933–016–0356-y>.
19. Špinar J, Vítovec J. Rok 2016 – rok srdečního selhání. Kardiol Rev Int Med 2016; 18(4): 229.
20. Špinar J, Hradec J, Špinarová L et al. Summary of the 2016 ESC Guidelines on the diagnosis and treatment of acute and chronic heart failure. Prepared by the Czech Society of Cardiology. Cor Vasa 2016; 58(5): e530-e568. Dostupné z DOI: <http://dx.doi.org/10.1016/j.crvasa.2016.09.004>.
21. Vítovec J, Špinar J, Špinarová L. Diabetes s kardiovaskulárním onemocněním. Acta Medicinae 2017; 6(2): 76–79.
22. Vítovec J, Špinar J, Špinarová L. Empagliflozin a srdeční selhání. Hypertenze a KV prevence 2016; 5(2): 19–23
23. Weber MA, Mansfield TA, Alessi F et al. Effects of dapagliflozin on blood pressure in hypertensive diabetic patients on renin-angiotensin system blockade. Blood Press 2016; 25(2): 93–103. Dostupné z DOI: <http://dx.doi.org/10.3109/08037051.2015.1116258>.
24. Zinman B, Wanner CH, Lachin JM et al. [EMPA-REG OUTCOME Investigators]. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015; 373(22): 2117–2128. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1504720>.
25. Neal B, Perkovic V, Mahaffey KW et al. [CANVAS Program Collaborative Group]. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med 2017; 377(7): 644–657. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1611925>.
26. Špinar J, Vítovec J, Špinarová L. SGLT2 – glifloziny – antidiabetika, antihypertenziva nebo léky na srdeční selhání. Kardiol Rev Int Med 2017; 19(3): 195–20
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Angiology Diabetology Internal medicine Cardiology General practitioner for adultsArticle was published in
Athero Review
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