Update on the Cardiovascular Benefits of Sodium-Glucose Co-Transporter-2 Inhibitors: Mechanism of Action, Available Agents and Comprehensive Review of Literature

Randa Abdelmasih, Ramy Abdelmaseih, Ravi Thakker, Mohammed Faluk, Arroj Ali, M. Mrhaf Alsamman, Syed Mustajab Hasan

Abstract


Despite the currently established treatment for heart failure (HF), HF remains a growing public healthcare problem with an increasing burden. Therefore, novel therapeutic innovations are needed to overcome this issue and improve HF prognosis. Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are state-of-the-art in type 2 diabetes mellitus management. They inhibit the reabsorption of glucose from the proximal renal tubules, leading to increased glycosuria and decreased plasma glucose levels. SGLT2i use is growing significantly, especially after recent clinical trials demonstrating favorable cardiovascular and renal protective effects independently of blood glucose-lowering. The mechanisms by which SGLT2i demonstrate their cardio-renal protective effects remain incompletely understood but are thought to be related to potential diuretic and natriuretic effects along with other mechanisms that will be discussed in this article. Over the past few years, there has been significant research on the safety, efficacy, and quality of this class of medications. Here, we review the current guideline-directed medical therapy for HF, focus on SGLT2i mechanism of action and potential role in HF patients, and finally summarize the cardiovascular clinical trials with SGLT2.




Cardiol Res. 2021;12(4):210-218
doi: https://doi.org/10.14740/cr1268

Keywords


Sodium-glucose cotransporter-2 inhibitors; Heart failure with reduced ejection fraction; Heart failure with preserved ejection fraction; Cardiovascular disease; Canagliflozin; Dapagliflozin; Empagliflozin; Ertugliflozin

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