Sodium-glucose cotransporter type 2 inhibitors in the treatment of chronic heart failure: new evidence

Abstract

Rational pharmacotherapy for chronic heart failure (HF) remains a relevant issue due to the unfavorable prognosis. Several major studies have confirmed the beneficial effect on reducing hospitalization rates and mortality of modern disease-modifying therapy, including sodium-glucose cotransporter type 2 inhibitors (SGLT-2 inhibitors or gliflozins), considered first-line therapy regardless of the left ventricular ejection fraction (LVEF) and diabetes mellitus in HF patients. The review presents the studied mechanisms of action of this group of drugs in HF, including metabolic, hemodynamic, and other pleiotropic effects, through which SGLT-2 inhibitors prevent the development and progression of HF with different LVEF. The possibilities of the influence of SGLT-2 inhibitors on clinical symptoms and quality of life of HF patients are discussed, as well as the change in the level of N-terminal pro-B-type natriuretic peptide as a target for rational clinical use justification. The concept of quadruple therapy, depending on the clinical situation, is presented, the basis of which is the rapid and simultaneous initiation of a combina-Rational pharmacotherapy for chronic heart failure (HF) remains a relevant issue due to the unfavorable prognosis. Several major studies have confirmed the beneficial effect on reducing hospitalization rates and mortality of modern disease-modifying therapy, including sodium-glucose cotransporter type 2 inhibitors (SGLT-2 inhibitors or gliflozins), considered first-line therapy regardless of the left ventricular ejection fraction (LVEF) and diabetes mellitus in HF patients. The review presents the studied mechanisms of action of this group of drugs in HF, including metabolic, hemodynamic, and other pleiotropic effects, through which SGLT-2 inhibitors prevent the development and progression of HF with different LVEF. The possibilities of the influence of SGLT-2 inhibitors on clinical symptoms and quality of life of HF patients are discussed, as well as the change in the level of N-terminal pro-B-type natriuretic peptide as a target for rational clinical use justification. The concept of quadruple therapy, depending on the clinical situation, is presented, the basis of which is the rapid and simultaneous initiation of a combination of major life-saving drug groups (angiotensin-converting enzyme inhibitors / sacubitril + valsartan, SGLT-2 inhibitors, beta-blockers, and mineralocorticoid receptor antagonists), aimed at improving the clinical condition and prognosis. Thus, a modern, effective approach to managing patients with HF and different LVEF necessarily includes the use of SGLT-2 inhibitors, which have sufficient evidence for their use in this category of patients.