Diabetes and SGLT2-iss inhibitors in patients with heart failure with preserved or mid-range left ventricular ejection fractions.
TL;DR: A review of the use of SGLT2-iss inhibitors for heart failure with preserved (HFpEF) or mid-range (HFmEF) cardiac ejection fractions is presented in this paper.
Abstract: Diabetic patients frequently develop heart failure with preserved (HFpEF) or mid-range (HFmEF) cardiac ejection fractions. This condition may be secondary to diabetic cardiomyopathy or one of several relevant comorbidities, mainly hypertension. Several mechanisms link diabetes to HFpEF or HFmEF. Among these, non-enzymatic glycation of interstitial proteins, lipotoxicity, and endothelial dysfunction may promote structural damage and ultimate lead to heart failure. Findings from several large-scale trials indicated that treatment with sodium/glucose cotransporter 2 inhibitors (SGLT2-iss) resulted in significant improvements in cardiovascular outcomes in diabetic patients with high cardiovascular risk. However, there is currently some evidence that suggests a clinical advantage of using SGLT2-iss specifically in cases of HFpEF or HFmEF. Preclinical and clinical studies revealed that SGLT2-iss treatment results in a reduction in left ventricular mass and improved diastolic function. While some of the beneficial effects of SGLT2-iss have already been characterized (e.g., increased natriuresis and diuresis as well as reduced blood pressure, plasma volume, and arterial stiffness, and nephron-protective activities), there is increasing evidence suggesting that SGLT2-iss may have direct actions on the heart. These findings include SGLT2-iss-mediated reductions in the expression of hypertrophic foetal genes and diastolic myofilaments stiffness, increases in global phosphorylation of myofilament regulatory proteins (in HFpEF), inhibition of cardiac late sodium channel current and Na+/H+ exchanger activity, metabolic shifts, and effects on calcium cycling. Preliminary data from previously published studies suggest that SGLT2-iss could be useful for the treatment of HFpEF and HFmEF. Several large ongoing trials, including DELIVER AND EMPEROR -preserved have been designed to evalute the efficacy of SGLT2-iss in improving clinical outcomes in patients diagnosed with HFpEF. The goal of this manuscript is to review the use of SGLT2-iss inhibitors for HFpEF or HFmEF associated with diabetes.
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TL;DR: This issue focuses on the important effects of antidiabetic drugs in specific population, namely, the elderly; patients with HF with preserved ejection fraction; and patients with pulmonary hypertension, as well as specific conditions related to muscle, pulmonary, and renal metabolism.
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TL;DR: The most frequent comorbidities were hypertension (78.3%), dislipemia (54%) and the fibrilación auricular (41,5%) as mentioned in this paper .
Abstract: Aunque se dispone de mejores diagnósticos y tratamientos, la insuficiencia cardíaca (IC) es una causa importante de muerte en España. El objetivo de este estudio es describir el tratamiento y las características de la población con IC crónica, clasificada según la fracción de eyección del ventrículo izquierdo (FEVI). Estudio observacional de cohortes de base poblacional en atención primaria (AP). Cataluña, 2014-2018. Se incluyeron pacientes adultos con diagnóstico incidente de IC clasificada según la FEVI. Análisis de los datos de salud registrados en la base de datos Sistema de Información para el Desarrollo de la Investigación en AP (SIDIAP). Demográficas, FEVI, comorbilidades y uso de fármacos para la IC. Se incluyeron 10.130 pacientes; el 18,9% con FEVI < 40 (ICFEr), el 15,9% con FEVI 40-49 (ICFEi) y el 65,2% con FEVI ≥ 50 (ICFEp), este último grupo con mayor proporción de mujeres (57,5%) y una mayor edad media (80,2 años). La población con ICFEi era similar a la de ICFEr en edad, género, comorbilidades o tratamiento. Las comorbilidades más frecuentes eran la hipertensión (78.3%), la dislipemia (54%) y la fibrilación auricular (41,5%). Los tratamientos más frecuentes fueron los β-bloqueantes, con diferencias según la FEVI (FEVIr 1.515 [79,2%], FEVIi 1.142 [70,8%] y FEVIp 3.371 [51,0%]), seguido de los diuréticos de asa (65,7%). El tratamiento farmacológico de la IC varía en función de la FEVI. El tratamiento y las características poblacionales de los pacientes con ICFEi son similares a aquellos con ICFEr. Despite better diagnoses and treatments, heart failure (HF) is an important cause of death in Spain. The objective of this study is to describe the characteristics and treatment of a population with chronic HF classified according to the left ventricular ejection fraction (LVEF). Population-based observational cohort study in Primary Health Care. Catalonia, Spain, during 2014–2018. Adults with HF classified by the LVEF. Analysis of electronic health data registered in SIDIAP (Information System for Research in Primary Care). Demographics, LVEF, comorbidities, and use of drugs for HF. 10,130 patients were included; 18.9% with LVEF<40 (HFrEF), 15.9% with LVEF 40-49 (HFmEF) and 65.2% with LVEF≥50 (HFpEF), this last group with a higher proportion of women (57.5%) and higher mean age (80.2 years-old). People with HFmEF were similar to those with HFrEF in age, gender, comorbidities and treatment. The most frequent comorbidities were hypertension (78.3%), dyslipidaemia (54%) and atrial fibrillation (41.5%). The most frequent pharmacological treatments were β blockers with differences according to the LVEF [HFrEF 1515 (79.2%), HFmEF 1142 (70.8%) and HFpEF 3371 (51%)], followed by loop diuretics (65.7%). HF is a prevalent disease. Having information on LVEF could guide its pharmacological management. The HF population has persistent cardiovascular risk factors and habits. Treatment and population characteristics of patients with HFmEF are similar to those with HFrEF.
TL;DR: The most frequent comorbidities were hypertension (78.3%), dislipemia (54%) and the fibrilación auricular (41,5%) as mentioned in this paper .
Abstract: Aunque se dispone de mejores diagnósticos y tratamientos, la insuficiencia cardíaca (IC) es una causa importante de muerte en España. El objetivo de este estudio es describir el tratamiento y las características de la población con IC crónica, clasificada según la fracción de eyección del ventrículo izquierdo (FEVI). Estudio observacional de cohortes de base poblacional en atención primaria (AP). Cataluña, 2014-2018. Se incluyeron pacientes adultos con diagnóstico incidente de IC clasificada según la FEVI. Análisis de los datos de salud registrados en la base de datos Sistema de Información para el Desarrollo de la Investigación en AP (SIDIAP). Demográficas, FEVI, comorbilidades y uso de fármacos para la IC. Se incluyeron 10.130 pacientes; el 18,9% con FEVI < 40 (ICFEr), el 15,9% con FEVI 40-49 (ICFEi) y el 65,2% con FEVI ≥ 50 (ICFEp), este último grupo con mayor proporción de mujeres (57,5%) y una mayor edad media (80,2 años). La población con ICFEi era similar a la de ICFEr en edad, género, comorbilidades o tratamiento. Las comorbilidades más frecuentes eran la hipertensión (78.3%), la dislipemia (54%) y la fibrilación auricular (41,5%). Los tratamientos más frecuentes fueron los β-bloqueantes, con diferencias según la FEVI (FEVIr 1.515 [79,2%], FEVIi 1.142 [70,8%] y FEVIp 3.371 [51,0%]), seguido de los diuréticos de asa (65,7%). El tratamiento farmacológico de la IC varía en función de la FEVI. El tratamiento y las características poblacionales de los pacientes con ICFEi son similares a aquellos con ICFEr. Despite better diagnoses and treatments, heart failure (HF) is an important cause of death in Spain. The objective of this study is to describe the characteristics and treatment of a population with chronic HF classified according to the left ventricular ejection fraction (LVEF). Population-based observational cohort study in Primary Health Care. Catalonia, Spain, during 2014–2018. Adults with HF classified by the LVEF. Analysis of electronic health data registered in SIDIAP (Information System for Research in Primary Care). Demographics, LVEF, comorbidities, and use of drugs for HF. 10,130 patients were included; 18.9% with LVEF<40 (HFrEF), 15.9% with LVEF 40-49 (HFmEF) and 65.2% with LVEF≥50 (HFpEF), this last group with a higher proportion of women (57.5%) and higher mean age (80.2 years-old). People with HFmEF were similar to those with HFrEF in age, gender, comorbidities and treatment. The most frequent comorbidities were hypertension (78.3%), dyslipidaemia (54%) and atrial fibrillation (41.5%). The most frequent pharmacological treatments were β blockers with differences according to the LVEF [HFrEF 1515 (79.2%), HFmEF 1142 (70.8%) and HFpEF 3371 (51%)], followed by loop diuretics (65.7%). HF is a prevalent disease. Having information on LVEF could guide its pharmacological management. The HF population has persistent cardiovascular risk factors and habits. Treatment and population characteristics of patients with HFmEF are similar to those with HFrEF.
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TL;DR: Authors/Task Force Members: Piotr Ponikowski* (Chairperson) (Poland), Adriaan A. Voors* (Co-Chair person) (The Netherlands), Stefan D. Anker (Germany), Héctor Bueno (Spain), John G. F. Cleland (UK), Andrew J. S. Coats (UK)
13,400 citations
TL;DR: ACCF/AHAIAI: angiotensin-converting enzyme inhibitor as discussed by the authors, angio-catabolizing enzyme inhibitor inhibitor inhibitor (ACS inhibitor) is a drug that is used to prevent atrial fibrillation.
Abstract: ACC/AHA
: American College of Cardiology/American Heart Association
ACCF/AHA
: American College of Cardiology Foundation/American Heart Association
ACE
: angiotensin-converting enzyme
ACEI
: angiotensin-converting enzyme inhibitor
ACS
: acute coronary syndrome
AF
: atrial fibrillation
7,489 citations
TL;DR: Patients treated with canagliflozin had a lower risk of cardiovascular events than those who received placebo but a greater risk of amputation, primarily at the level of the toe or metatarsal.
Abstract: BackgroundCanagliflozin is a sodium–glucose cotransporter 2 inhibitor that reduces glycemia as well as blood pressure, body weight, and albuminuria in people with diabetes. We report the effects of treatment with canagliflozin on cardiovascular, renal, and safety outcomes. MethodsThe CANVAS Program integrated data from two trials involving a total of 10,142 participants with type 2 diabetes and high cardiovascular risk. Participants in each trial were randomly assigned to receive canagliflozin or placebo and were followed for a mean of 188.2 weeks. The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. ResultsThe mean age of the participants was 63.3 years, 35.8% were women, the mean duration of diabetes was 13.5 years, and 65.6% had a history of cardiovascular disease. The rate of the primary outcome was lower with canagliflozin than with placebo (occurring in 26.9 vs. 31.5 participants per 1000 patient-years; hazard ratio, 0.86; 95% c...
4,842 citations
TL;DR: The addition of enalapril to conventional therapy in patients with severe congestive heart failure can reduce mortality and improve symptoms, and the effect seems to be due to a reduction in death from progression of heart failure.
Abstract: To evaluate the influence of the angiotensin-converting enzyme inhibitor, enalapril (2.5 to 40 mg/day), on the prognosis of severe congestive heart failure, defined as New York Heart Association functional class IV, a double-blind study was undertaken in which 253 patients were randomized to receive either placebo (n = 126) or enalapril (n = 127) in addition to conventional treatment, including vasodilators. Follow-up averaged 188 days (range 1 day to 20 months). The reduction in crude mortality within 6 months (primary objective) was 40% in the enalapril-treated group (from 44 to 26%, p = 0.002) and within 1 year 31% (p = 0.001). By the end of the study, 68 subjects in the placebo group and 50 in the enalapril group had died--a reduction of 27% (p = 0.003). The entire reduction in total mortality (50%) was found in patients dying from progressive heart failure, whereas no difference was seen in the incidence of sudden cardiac death. There was a significant improvement in New York Heart Association classification in the enalapril group, together with a reduction in heart size and a reduced requirement for other heart failure medication. It is concluded that the addition of enalapril to conventional therapy in patients with severe congestive heart failure can reduce mortality and improve symptoms. The effect seems to be due to a reduction in death from progression of heart failure.
4,328 citations
University of Glasgow1, Brigham and Women's Hospital2, Yale University3, University of Copenhagen4, University of Missouri–Kansas City5, National University of Cordoba6, Wrocław Medical University7, Harvard University8, University of Minnesota9, Charles University in Prague10, Saarland University11, Taipei Veterans General Hospital12, National Yang-Ming University13, Slovak Medical University14, Fudan University15, Libin Cardiovascular Institute of Alberta16, University of Calgary17, Sofia Medical University18, University of Gothenburg19, Semmelweis University20, University of São Paulo21, Montreal Heart Institute22, University of Toronto23, Uppsala University24, University of Wisconsin-Madison25, AstraZeneca26
TL;DR: Among patients with heart failure and a reduced ejection fraction, the risk of worsening heart failure or death from cardiovascular causes was lower among those who received dapagliflozin than amongThose who received placebo, regardless of the presence or absence of diabetes.
Abstract: Background In patients with type 2 diabetes, inhibitors of sodium–glucose cotransporter 2 (SGLT2) reduce the risk of a first hospitalization for heart failure, possibly through glucose-ind...
3,541 citations