Division of Clinical Pharmacology, Centre for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium.
Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Liège, Liège, Belgium.
Expert Opin Drug Metab Toxicol. 2022 Jun;18(6):381-393. doi: 10.1080/17425255.2022.2105693. Epub 2022 Aug 2.
Heart failure (HF) is becoming a huge public health burden. New diabetes drugs for type 2 diabetes (T2D), sodium-glucose cotransporter type 2 inhibitors (SGLT2is), reduce the rate of hospitalization for HF in placebo-controlled trials.
Pharmacokinetics of dapagliflozin and empagliflozin (in presence of renal impairment and hepatic dysfunction, two comorbidities frequently associated with HF) and pharmacodynamic studies in patients with HF. Main HF outcomes in T2D patients with cardiovascular risk and in patients with reduced (HFrEF) or preserved (HFpEF) ejection fraction, with or without T2D, from DAPA-HF, EMPEROR-Reduced and EMPEROR-Preserved original findings and post hoc analyses.
No clinically relevant changes are expected concerning SGLT2i pharmacokinetics in patients with HF while pharmacodynamic studies reported improvements in myocardium/vascular parameters, biomarkers, and functional status. All SGLT2is showed a remarkable reduction in hospitalization for HF in patients with T2D and high cardiovascular risk. Furthermore, both dapagliflozin and empagliflozin improved the prognosis of patients with HFrEF, independently of the presence of T2D. Similar results were reported with empagliflozin in patients with HFpEF, to be confirmed with dapagliflozin in an ongoing trial (DELIVER). Thus, SGLT2is offer a new opportunity for the prevention and management of HF in patients with or without T2D.
心力衰竭（HF）正成为一个巨大的公共卫生负担。新型 2 型糖尿病（T2D）药物，钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2is），在安慰剂对照试验中降低了 HF 住院率。
达格列净和恩格列净的药代动力学（在存在肾功能损害和肝功能障碍的情况下，这两种合并症常与 HF 相关）以及 HF 患者的药效学研究。有心血管风险的 T2D 患者和射血分数降低（HFrEF）或保留（HFpEF）的患者（无论是否患有 T2D）的主要 HF 结局，来自 DAPA-HF、EMPEROR-Reduced 和 EMPEROR-Preserved 的原始发现和事后分析。
在 HF 患者中，预计 SGLT2i 的药代动力学不会发生任何临床相关变化，而药效学研究报告了心肌/血管参数、生物标志物和功能状态的改善。所有 SGLT2is 均显著降低了 T2D 和高心血管风险患者的 HF 住院率。此外，达格列净和恩格列净均改善了 HFrEF 患者的预后，无论是否存在 T2D。在 HFpEF 患者中，恩格列净也报告了类似的结果，尚需一项正在进行的试验（DELIVER）用达格列净来证实。因此，SGLT2is 为 T2D 患者和非 T2D 患者 HF 的预防和治疗提供了新的机会。
