Sodium-glucose transporter 2 inhibitors in heart failure with preserved ejection fraction

Background: After sodium-glucose transporter 2 (SGLT2) inhibitors showed significant reductions of clinical endpoints (cardiovascular death and hospitalization for heart failure) in the treatment of heart failure with reduced ejection fraction, it was investigated whether they achieve similar beneficial effects in heart failure with preserved and moderately reduced ejection fraction (HFpEF and HFmrEF).Objective: A summary of new data on SGLT2 inhibitors in patients with HFpEF and HFmrEF is presented.Material and methods: A selective literature search was carried out.Results and discussion: Randomized controlled endpoint studies for dapagliflozin (DELIVER) and empagliflozin (EMPEROR-preserved) were reported for HFpEF and HFmrEF in patients with and without diabetes. Compared to placebo they showed an improvement in the primary combined endpoint of cardiovascular-related fatalities and hospitalization due to deterioration of heart failure (the dapagliflozin study additionally included an urgent consultation because of deterioration of the heart failure component of the endpoint). For dapagliflozin the primary endpoint relative to placebo was reduced to 16.4% compared to 19.5% for placebo (hazard ratio 0.82, 95% confidence interval 0.73-0.92, p < 0.001). Similar results were shown for empagliflozin (13.8% vs. 17.1%, hazard ratio 0.79, 95% confidence interval 0.69-0.90, p < 0.001). Most of the prespecified secondary endpoints were also reduced by theSGLT2 inhibitors in both studies.Conclusion: As the first drug class, SGLT2 inhibitors showed a significant reduction of clinical endpoints in HFpEF and HFmrEF. Therefore, SGLT2 inhibitors exhibit a protective effect in patients with heart failure across the entire spectrum of left ventricular ejection fractions.