Sodium glucose co-transporter 2 (SGLT2) inhibitor use in patients with heart failure with preserved ejection fraction (HFpEF) has generated great enthusiasm, noted Rudolf de Boer, MD, PhD, clinical cardiologist and professor of translational cardiology, University Medical Center Groningen, the Netherlands.
The data on using sodium glucose co-transporter 2 (SGLT2) inhibitors in patients with heart failure with preserved ejection fraction (HFpEF) have generated great enthusiasm, although we still don't quite know how to explain all of the salutary effects, noted Rudolf de Boer, MD, PhD, clinical cardiologist and professor of translational cardiology, University Medical Center Groningen, the Netherlands.
De Boer presented “HFpEF Management: State of the Art SGLT2 Inhibitors” today at ESC Congress 2021, this year’s virtual annual meeting of the European Society of Cardiology.
What did your presentation on SGLT2 inhibitors in HFpEF address?
There's been ample interest for the use of SGLT2 inhibitors in heart failure with preserved ejection fraction, and that mainly has to do with the fact that, during this ESC, the EMPEROR-Preserved trial was presented, which is the first morbidity/mortality trial in HFpEF with an SGLT2 inhibitor. The primary end point was effectively reduced by the use of the SGLT2 inhibitors. So that clearly sparks enthusiasm and has attracted a lot of interest.
My talk dealt with the aggregate evidence that has been obtained for SGLT2 inhibition in heart failure with preserved ejection fraction. And clearly before this trial was presented, there were already quite a few signals from other trials, post hoc analyses, some smaller-scale trials, that these drugs, indeed, could be efficacious with regards to reducing end points.
I discussed a series of those studies. There were a few large field trials in the past in type 2 diabetes patients—most notably EMPA-REG, CANVAS, DECLARE-TIMI, and the VERTIS trials—that clearly send signals for a potentially beneficial effect in HFpEF. We've seen quite recently the SOLOIST and the SCORED trials that were presented during the American Heart Association in 2020 and in post hoc analyses of these trials. The patients with HFpEF fared well when allocated to SGLT2 inhibitors.
There were a few smaller trials, and I also discussed some of the potential working mechanisms that might underlie the beneficial effects. To summarize that, I think as it stands now, we still don't know which of the effects of the SGLT2 inhibitors explain all of the salutary effects. But clearly they're very pleiotropic drugs with a number of effects, and clearly, in combination, these effects exert very beneficial effects. So that was, in a nutshell, what I discussed.