Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, EL Paso, TX 79905, United States.
Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland.
Cardiovasc Hematol Disord Drug Targets. 2021;21(1):1-6. doi: 10.2174/1871529X20999201231205504.
Heart failure (HF) is one of the leading public health problems with a substantial burden in the global healthcare system. Although significant efforts are based on prevention, early recognition, and proper management of HF, the worldwide surge of risk factors like hypertension, diabetes, and obesity has further complicated the existing problem.
This study aims to define the role of the sodium-glucose cotransporter 2 (SGLT2) inhibitors in non-diabetic HF.
We performed a comprehensive literature review to examine the available evidence in the clinical implications of SGLT2 inhibitors in non-diabetic HF using the online databases (PubMed and Embase).
We identified two RCTs-DAPA-HF and DEFINE-HF, which were conducted to analyze the net clinical benefit of dapagliflozin in non-diabetic HF patients. Although we could not study the composite effects of these studies due to the difference in outcome measures, the individual outcomes look promising. The number needed to treat (NNT) to prevent one primary event was 21 (95% CI: 15 to 38) in the DAPA study. In DEFINE HF study, responder analysis showed a significant proportion of patients in the treatment arm experienced improvements in the functional status with clinically meaningful improvement in KCCQ-OS by 3.7 points and KCCQ-CS by 4.6 points with NNT of 10 and 7, respectively, at 12 weeks. Both studies also showed low safety concerns in patients without T2D.
The outcomes of the two RCTs, DAPA-HF and DEFINE-HF, that studied the effects of SGLT2 inhibitors in non-diabetic HF showed promising clinical outcomes. Although we are waiting for other prospective RCTs to reflect similar results and safety profiles, it seems the SGLT2 inhibitors can have broader clinical implications in managing non-diabetic HF with improved cardiovascular outcomes.
心力衰竭（HF）是全球医疗保健系统面临的主要公共卫生问题之一，负担沉重。尽管在 HF 的预防、早期识别和适当管理方面做出了重大努力，但高血压、糖尿病和肥胖等风险因素在全球范围内的激增，使现有问题更加复杂。
本研究旨在确定钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂在非糖尿病性 HF 中的作用。
我们进行了全面的文献综述，使用在线数据库（PubMed 和 Embase）研究 SGLT2 抑制剂在非糖尿病性 HF 中的临床意义的现有证据。
我们确定了两项 RCT 研究——DAPA-HF 和 DEFINE-HF，旨在分析达格列净在非糖尿病性 HF 患者中的净临床获益。尽管由于结局测量的差异，我们无法研究这些研究的综合效果，但个别结局看起来很有希望。DAPA 研究中，预防首次主要事件的需要治疗人数（NNT）为 21（95%CI：15 至 38）。在 DEFINE HF 研究中，应答者分析显示，治疗组中有相当一部分患者的功能状态得到改善，KCCQ-OS 改善了 3.7 分，KCCQ-CS 改善了 4.6 分，NNT 分别为 10 和 7，在 12 周时。两项研究还显示，在没有 T2D 的患者中，安全性问题较低。
两项 RCT 研究（DAPA-HF 和 DEFINE-HF）研究了 SGLT2 抑制剂在非糖尿病性 HF 中的作用，结果显示出有希望的临床结局。尽管我们正在等待其他前瞻性 RCT 来反映类似的结果和安全性特征，但 SGLT2 抑制剂似乎可以在改善心血管结局的情况下，更广泛地应用于非糖尿病性 HF 的治疗。
