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Review
. 2023 Jan 3;12(1):379.
doi: 10.3390/jcm12010379.

Gliflozins: From Antidiabetic Drugs to Cornerstone in Heart Failure Therapy-A Boost to Their Utilization and Multidisciplinary Approach in the Management of Heart Failure

Lorenzo Pistelli  1 , Francesca Parisi  1 , Michele Correale  2 , Federica Cocuzza  1 , Francesca Campanella  1 , Tommaso de Ferrari  1 , Pasquale Crea  1 , Rosalba De Sarro  1 , Olga La Cognata  1 , Simona Ceratti  1 , Tonino Recupero  1 , Gaetano Ruocco  3 , Alberto Palazzuoli  4 , Egidio Imbalzano  1 , Giuseppe Dattilo  1
Affiliations
Review

Gliflozins: From Antidiabetic Drugs to Cornerstone in Heart Failure Therapy-A Boost to Their Utilization and Multidisciplinary Approach in the Management of Heart Failure

Lorenzo Pistelli et al. J Clin Med. .

Abstract

Heart failure (HF) is a complex, multifactorial, progressive clinical condition affecting 64.3 million people worldwide, with a strong impact in terms of morbidity, mortality and public health costs. In the last 50 years, along with a better understanding of HF physiopathology and in agreement with the four main models of HF, many therapeutic options have been developed. Recently, the European Society of Cardiology (ESC) HF guidelines enthusiastically introduced inhibitors of the sodium-glucose cotransporter (SGLT2i) as first line therapy for HF with reduced ejection fraction (HFrEF) in order to reduce hospitalizations and mortality. Despite drugs developed as hypoglycemic agents, data from the EMPA-REG OUTCOME trial encouraged the evaluation of the possible cardiovascular effects, showing SGLT2i beneficial effects on loading conditions, neurohormonal axes, heart cells' biochemistry and vascular stiffness, determining an improvement of each HF model. We want to give a boost to their use by increasing the knowledge of SGLT2-I and understanding the probable mechanisms of this new class of drugs, highlighting strengths and weaknesses, and providing a brief comment on major trials that made Gliflozins a cornerstone in HF therapy. Finally, aspects that may hinder SGLT2-i widespread utilization among different types of specialists, despite the guidelines' indications, will be discussed.

Keywords: SGLT-2 inhibitors; chronic heart failure; gliflozins; heart failure; pharmacological therapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Effects of SGLT2-i on the cardio-renal model.
Figure 2
Figure 2
Effects of SGLT2-i on a neurohormonal model and on inflammatory markers.
Figure 3
Figure 3
Effects of SGLT2-i on the cardio-circulatory model.
Figure 4
Figure 4
Effects of SGLT2-i on the biochemical model.
See this image and copyright information in PMC

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