Crispino Simone Pasquale, Segreti Andrea, Nafisio Vincenzo, Valente Daniele, Crisci Filippo, Ferro Aurora, Cavallari Ilaria, Nusca Annunziata, Ussia Gian Paolo, Grigioni Francesco
Department of Cardiovascular Sciences, Fondazione Policlinico Campus Bio-Medico di Roma, 00128 Rome, Italy.
Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", 00135 Rome, Italy.
Biomedicines. 2025 Mar 3;13(3):608. doi: 10.3390/biomedicines13030608.
Sodium-glucose cotransporter-2 inhibitors (SGLT2i), initially developed as antihyperglycemic agents, have revolutionized heart failure (HF) management, offering substantial benefits across all stages and phenotypes of the disease. Regardless of left ventricular ejection fraction (LVEF), these agents have proven efficacy in both chronic and acute HF presentations. This review explores SGLT2i applications spanning the HF continuum, from early stages (Stage A) in at-risk individuals to the mitigation of progression in advanced HF (Stage D). Evidence from numerous trials has shown that SGLT2i significantly lower rates of HF hospitalization, improve renal function, and decreases cardiovascular mortality, highlighting their multifaced mechanisms of action in HF care. This review also highlights the potential mechanisms by which SGLT2i exert their beneficial effects on the cardiovascular and renal systems, each contributing to early and sustained clinical improvements. However, the integration of SGLT2i into guideline-directed medical therapy poses practical challenges, including initiation timing, dosing, and monitoring, which are addressed to support effective treatment adaptation across patient populations. Ultimately, this review provides a comprehensive assessment of SGLT2i as a foundational therapy in HF, emphasizing their role as an intervention across multiple stages aimed at improving outcomes across the entire HF spectrum.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）最初作为抗高血糖药物开发，彻底改变了心力衰竭（HF）的管理方式，在该疾病的所有阶段和表型中都带来了显著益处。无论左心室射血分数（LVEF）如何，这些药物在慢性和急性HF表现中均已证明具有疗效。本综述探讨了SGLT2i在HF连续过程中的应用，从高危个体的早期阶段（A期）到晚期HF（D期）进展的缓解。众多试验的证据表明，SGLT2i可显著降低HF住院率、改善肾功能并降低心血管死亡率，突出了它们在HF治疗中多方面的作用机制。本综述还强调了SGLT2i对心血管和肾脏系统发挥有益作用的潜在机制，每种机制都有助于早期和持续的临床改善。然而，将SGLT2i纳入指南指导的药物治疗带来了实际挑战，包括起始时机、剂量和监测，本文将对这些问题进行探讨，以支持针对不同患者群体进行有效的治疗调整。最终，本综述对SGLT2i作为HF的基础治疗进行了全面评估，强调了它们作为一种跨多个阶段的干预措施，旨在改善整个HF谱的预后的作用。
