Diabetes Medication Improves Outcomes for Heart Failure Patients

Human heart with bronchial tree, illustration

A type of medication developed for treating diabetes could be also be effective for treating all patients with heart failure, according to researchers from the University of East Anglia.

Sodium-glucose co-transporter-2 (SGLT2) inhibitors were first approved to treat type 2 diabetes in 2012 and their main mechanism of action is to block reabsorption of glucose in the kidney and, in so doing, lower blood sugar.

Earlier research has identified that these drugs also have a beneficial effect in around half of heart failure patients, those with reduction ejection fraction. Heart failure affects around 5.8 million people in the U.S. and more than half a million new cases are diagnosed each year. The primary cause of heart failure varies significantly between individuals and can be hard to pin down, making treatment difficult.

The new study suggests that the cardiovascular benefits of SGLT2 inhibitors could be much larger than previously thought and be relevant for all heart failure patients, including the half with preserved ejection fraction, a type of heart failure that has historically been difficult to treat.

As described in the European Journal of Preventive Cardiology, the researchers carried out a systematic review and meta-analysis of five studies looking at the impact of SGLT2 inhibitors such as dapagliflozin, canagliflozin, empagliflozin or ertugliflozin on heart failure.

The studies included 9,726 patients with a preserved ejection fraction of over 45%, 5,046 of whom received a SGLT2 inhibitor and 4,680 a placebo. The primary endpoint of the analysis was cardiovascular death and hospitalization for heart failure.

The scientists found that patients taking SGLT2 inhibitors were 22% less likely to die from cardiovascular disease or be hospitalized for heart failure exacerbation than those in the placebo group. Overall mortality was not improved, however, suggesting that other factors also play an important role in the health of these patients.

“This is very important because this is the first medication that can provide a benefit to this previously untreatable group of patients – in terms of heart-related deaths or hospitalization,” said Vassilios Vassiliou, a professor at Norwich Medical School, who led the study, in a press statement.

“Previous studies had shown that this medication would be beneficial in heart failure with reduced ejection fraction. But we found that it can also help heart failure patients with preserved ejection fraction.”

Although these results are promising, the researchers emphasize that additional large-scale trials are needed to validate their results and further assess the benefit of SGLT2 inhibitors in patients with preserved ejection fraction heart failure.

They note that while most of the patients included in this meta-analysis had diabetes at baseline, the cardioprotective benefits of these drugs have been shown to occur via mechanisms independent of diabetes status suggesting the benefit is not unique to diabetic patients.

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