Sodium-glucose co-transporter 2 inhibitors should be the standard of care for treatment of most patients with heart failure and reduced ejection fraction irrespective of presence of diabetes

Abstract

Background: Recent well-designed trials have shown that Sodium-Glucose Co-Transporter 2 (SGLT2) inhibitors decrease Heart Failure Hospitalization (HFH) in patients with or without type 2 diabetes. Methods: Review of literature [p2] (English, French, Spanish) from January 1990 to December 20, 2019. Key words included heart failure, sodium-glucose co-transporter 2, SGLT2 inhibitors, safety, randomized trials, and meta-analysis. Expert opinions and guidelines are also reviewed. Results: The use of SGLT2 inhibitors in patients with type 2 diabetes was associated with significant relative reduction in HFH by [p3] 27-35%. The latter reduction is most likely a class effect and is consistent in patients with various degrees of Cardiovascular (CV) risk at baseline. In patients with Heart Failure and Reduced Ejection Fraction (HFrEF), dapagliflozin decreased risk of a composite outcome of worsening Heart Failure (HF) or CV death by 26%, as well as the secondary outcomes of HFH by 30% and death from any cause by 17%. Moreover, dapagliflozin decreased severity of symptoms of heart failure. Importantly, the amelioration of previous outcomes was similar in patients with or without diabetes. Dapagliflozin did not cause major hypoglycemia in non- diabetic patients with heart failure. However, patients with advanced HFrEF with New York Heart Association (NYHA) class IV were not included. Conclusions: SGLT2 inhibitors should be added to the standard care [p4] in most patients with HFrEF in presence or absence of type 2 diabetes.