Department of Cardiac Surgery, Mitera Hospital, 6 Erythrou Stavrou Street, 15123, Marousi, Athens, Greece.
Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Curr Pharm Des. 2021;27(8):1051-1060. doi: 10.2174/1381612826666201103122813.
Type 2 diabetes mellitus (DM) is associated with a considerable risk of cardiovascular and renal diseases, including heart failure. Sodium-glucose co-transporter 2 (SGLT2) inhibitors have demonstrated unprecedented cardiorenal protective effects in large-scale clinical trials of patients with or without diabetes and either established cardiovascular disease (CV) or multiple CV risk factors.
Herein we aim to focus on the role of SGLT2 inhibitors regarding the improvement in heart failure outcomes and the proposed mechanisms of action by which these drugs confer their beneficial effect.
PubMed, Embase, and Google Scholar databases were searched to identify eligible articles that are comprehensively summarized and discussed in this study.
The most commonly discussed mechanisms of action are diuresis and natriuresis, reduction in preload, afterload, and ventricular mass, as well as stimulation of erythropoietin production and improved myocardial energetics. SGLT2 inhibitors improve outcomes in patients with established heart failure (HF) and reduce the risk of death and HF admissions in patients with established chronic HF with reduced ejection fraction (HFrEF), either with or without diabetes.
Potential key mechanisms that may explain the notable cardioprotective benefits of SGLT2 inhibitors have been outlined. These agents have recently received class Ia recommendation in specific groups of people with DM to lower the risk of hospitalization for HF and risk of death, while these benefits may also extend to people without diabetes. It remains to be seen whether they will also emerge as treatment approaches in the acute phase of CV episodes.
2 型糖尿病（DM）与心血管和肾脏疾病（包括心力衰竭）的风险显著相关。钠-葡萄糖协同转运蛋白 2（SGLT2）抑制剂在伴有或不伴有糖尿病以及已存在心血管疾病（CV）或多种 CV 危险因素的患者的大型临床试验中表现出了前所未有的心脏和肾脏保护作用。
本文旨在重点关注 SGLT2 抑制剂在改善心力衰竭结局方面的作用以及这些药物发挥其有益作用的可能作用机制。
通过检索 PubMed、Embase 和 Google Scholar 数据库，确定了本文中全面总结和讨论的合格文章。
最常讨论的作用机制是利尿和利钠作用、降低前负荷、后负荷和心室质量，以及刺激促红细胞生成素的产生和改善心肌能量学。SGLT2 抑制剂可改善已确诊心力衰竭（HF）患者的结局，并降低已确诊射血分数降低的慢性 HF（HFrEF）患者（无论是否患有糖尿病）的死亡和 HF 入院风险。
已经概述了可能解释 SGLT2 抑制剂显著心脏保护益处的关键机制。这些药物最近在特定的糖尿病患者群体中被推荐为 I 类药物，以降低因 HF 住院和死亡的风险，而这些益处也可能扩展到没有糖尿病的人群。它们是否也将成为心血管事件急性期的治疗方法仍有待观察。
