Department of Medicine, Cook County Health and Hospital System, Chicago, IL, USA.
Heart and Vascular Center, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
Curr Diab Rep. 2020 Oct 11;20(11):63. doi: 10.1007/s11892-020-01347-3.
We highlight the unique properties of the sodium-glucose cotransporter-2 (SGLT-2 inhibitors) which may lend favorably to their efficient integration in the background of other heart failure (HF) therapies. We also discuss the unique aspects of SGLT-2 inhibitor dosing, lack of titration needs, effects on kidney function and electrolytes, diuretic activity, and safety in the high-risk peri-hospitalization window.
Dapagliflozin was recently approved for the treatment of heart failure with reduced ejection fraction (HFrEF), irrespective of the presence or absence of type 2 diabetes mellitus (T2DM) based on the findings of the pivotal DAPA-HF trial. All SGLT-2 inhibitors are once daily medications with minimal drug-drug interactions and do not require titration (for HF treatment) unlike other HF medications. SGLT-2 inhibitors offer modest weight loss and blood pressure reduction without major adverse effects of hyperkalemia, making it ideal for near-simultaneous initiation with other HF medications, and use in high-risk populations (including older adults). Moreover, SGLT-2 inhibitors appear to afford long-term kidney protection in diverse populations. SGLT-2 inhibitors are the latest class of therapies to demonstrate important clinical benefits among patients with HFrEF, and their pharmacological properties favor ease of use and integration in multi-drug disease-modifying regimens.
我们强调了钠-葡萄糖共转运蛋白-2（SGLT-2 抑制剂）的独特特性，这些特性可能使其在心力衰竭（HF）其他治疗方法的背景下得到有效整合。我们还讨论了 SGLT-2 抑制剂剂量的独特方面、无需滴定、对肾功能和电解质的影响、利尿作用以及在高风险围手术期窗口的安全性。
达格列净最近根据关键的 DAPA-HF 试验结果，被批准用于射血分数降低的心力衰竭（HFrEF）的治疗，无论是否存在 2 型糖尿病（T2DM）。所有 SGLT-2 抑制剂均为每日一次的药物，与其他 HF 药物不同，药物相互作用最小且无需滴定（用于 HF 治疗）。SGLT-2 抑制剂可适度减轻体重和降低血压，且不会引起高钾血症等严重不良反应，因此非常适合与其他 HF 药物同时起始使用，并可用于高危人群（包括老年人）。此外，SGLT-2 抑制剂似乎可在不同人群中提供长期的肾脏保护。SGLT-2 抑制剂是最新一类可在 HFrEF 患者中显示重要临床获益的治疗药物，其药理特性有利于使用方便并整合到多药物疾病修正治疗方案中。
