Department of Pharmacy Practice, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA.
Am J Health Syst Pharm. 2023 Jun 22;80(13):818-826. doi: 10.1093/ajhp/zxad061.
This review describes the evidence from randomized controlled trials (RCTs) regarding the effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors on cardiovascular (CV) clinical outcomes when therapy is initiated during acute heart failure (HF).
SGLT2 inhibitors have become a cornerstone of guideline-directed medical therapy (GDMT) for type 2 diabetes mellitus, chronic kidney disease, and HF. Because of their ability to promote natriuresis and diuresis as well as other potentially beneficial CV effects, use of SGLT2 inhibitors has been investigated when therapy is initiated during hospitalization for acute HF. We identified 5 placebo-controlled RCTs that reported CV clinical outcomes incorporating one or more components of all-cause mortality, CV mortality, CV hospitalization, HF worsening, and hospitalization for HF in patients treated with empagliflozin (n = 3 trials), dapagliflozin (n = 1 trial), and sotagliflozin (n = 1 trial). Nearly all CV outcomes in these trials showed benefit with SGLT2 inhibitor use during acute HF. Incidence of hypotension, hypokalemia, and acute renal failure was generally similar to that with placebo. These findings are limited by heterogeneous outcome definitions, variation in time to SGLT2 inhibitor initiation, and small sample sizes.
SGLT2 inhibitors may have a role in inpatient management of acute HF, provided there is close monitoring for fluctuations in hemodynamic, fluid, and electrolyte status. Initiation of SGLT2 inhibitors at the time of acute HF may promote optimized GDMT, continued medication adherence, and reduced risk of CV outcomes.
本综述描述了随机对照试验（RCT）的证据，即在急性心力衰竭（HF）住院期间开始治疗时，钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂对心血管（CV）临床结局的影响。
SGLT2 抑制剂已成为 2 型糖尿病、慢性肾脏病和 HF 指南指导的药物治疗（GDMT）的基石。由于其具有促进排钠利尿以及其他潜在有益的 CV 作用的能力，因此在急性 HF 住院期间开始治疗时，已对 SGLT2 抑制剂的使用进行了研究。我们确定了 5 项安慰剂对照 RCT，这些 RCT 报告了 CV 临床结局，其中包含全因死亡率、CV 死亡率、CV 住院、HF 恶化以及 HF 住院的一个或多个组成部分，接受恩格列净（n = 3 项试验）、达格列净（n = 1 项试验）和索格列净（n = 1 项试验）治疗的患者。这些试验中的几乎所有 CV 结局均显示急性 HF 期间使用 SGLT2 抑制剂有益。低血压、低钾血症和急性肾衰竭的发生率通常与安慰剂相似。这些发现受到结局定义的异质性、SGLT2 抑制剂开始时间的变化以及样本量小的限制。
只要密切监测血流动力学、液体和电解质状态的波动，SGLT2 抑制剂可能在急性 HF 的住院管理中发挥作用。在急性 HF 时开始使用 SGLT2 抑制剂可能会促进优化的 GDMT、持续的药物依从性以及降低 CV 结局的风险。
