Clinical Pharmacy Department, Methodist University Hospital, Memphis, Tennessee (Drs March, Lukas, and Cave); University of Tennessee Health Science Center, College of Pharmacy, Memphis (Drs March, Lukas, and Cave); and University of Wisconsin Hospitals and Clinics, Madison (Drs Berei and Shah).
Crit Care Nurs Q. 2022;45(2):189-198. doi: 10.1097/CNQ.0000000000000401.
Sodium-glucose cotransporter-2 (SGLT-2) inhibitors (empagliflozin, canagliflozin, dapagliflozin, and ertugliflozin) are a new class of heart failure medications that have previously been exclusively utilized in the management of type 2 diabetes mellitus (T2DM). The rationale for using SGLT-2 inhibitors in patients with heart failure has stemmed from recent landmark clinical trials in T2DM in which reductions in mortality and hospitalization for heart failure were first observed. On the basis of these robust outcomes, empagliflozin has further been evaluated in heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction and dapagliflozin solely in the management of HFrEF. While cardiovascular outcomes among each agent vary depending on the patient population, updates among both the American and European guidelines have included SGLT-2 inhibitors as pillars of therapy. The exact mechanisms for how SGLT-2 inhibitors are beneficial in heart failure are unknown, but current hypotheses include multiple metabolic and hemodynamic mechanisms. The purpose of this review is to summarize available literature focusing on the use of the SGLT-2 inhibitors as adjunctive therapy in heart failure, as well as evaluate mechanisms for heart failure benefit, adverse effects, and practical considerations for using these agents in the clinical setting.
钠-葡萄糖共转运蛋白 2（SGLT-2）抑制剂（恩格列净、卡格列净、达格列净和埃格列净）是一类新型心力衰竭药物，以前专门用于治疗 2 型糖尿病（T2DM）。在心力衰竭患者中使用 SGLT-2 抑制剂的依据源自最近在 T2DM 中进行的具有里程碑意义的临床试验，首次观察到死亡率和心力衰竭住院率降低。基于这些可靠的结果，恩格列净进一步在射血分数降低的心力衰竭（HFrEF）和射血分数保留的心力衰竭中进行了评估，而达格列净仅在 HFrEF 的管理中进行了评估。尽管每种药物的心血管结局因患者人群而异，但美国和欧洲指南的更新都将 SGLT-2 抑制剂作为治疗的基石。SGLT-2 抑制剂在心力衰竭中有益的具体机制尚不清楚，但目前的假设包括多种代谢和血液动力学机制。本综述的目的是总结现有文献，重点关注 SGLT-2 抑制剂作为心力衰竭辅助治疗的应用，并评估心力衰竭获益、不良反应以及在临床环境中使用这些药物的实际考虑因素。
