Minireview: are SGLT2 inhibitors heart savers in diabetes?
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Minireview: are SGLT2 inhibitors heart savers in diabetes? Petra Grubić Rotkvić 1
&
Maja Cigrovski Berković 2,3 & Nikola Bulj 4 & Luka Rotkvić 5
# Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Sodium-glucose cotransporter 2 (SGLT2) inhibitors, a class of drugs that promote urinary glucose excretion in the treatment of diabetes, have provoked large interest of scientific and professional community due to their positive and, somehow, unexpected results in the three major cardiovascular outcome trials (EMPA-REG OUTCOME trial with empagliflozin, CANVAS Program with canagliflozin, and DECLARE-TIMI 58 with dapagliflozin). In fact, along with the reduction of major adverse cardiovascular events, SGLT2 inhibitors reduced significantly hospitalization for heart failure regardless of existing atherosclerotic cardiovascular disease or a history of heart failure. The latter have reminded us of the frequent but neglected entity of diabetic cardiomyopathy which is currently poorly understood despite its great clinical importance. Physiological mechanisms responsible for the benefits of SGLT2 inhibitors are complex and multifactorial and still not well defined. Interestingly, the time frame of their effect excludes a glucose- and antiatherosclerotic-mediated effect. It would be of great importance to better understand SGLT2 inhibitor mechanisms of action since they could have a potential to be used in early stages of diabetes as cardioprotective agents. There are widely available biomarkers as well as echocardiography that are used in everyday clinical practice and could elucidate physiological mechanisms in the heart protection with SGLT2 inhibitors treatment but studies are still lacking. The purpose of this minireview is to summarize the latest concepts about SGLT2 inhibitors and its benefits regarding diabetic cardiomyopathy especially on its early stage development and to discuss controversies and potential future developments in the field. Keywords SGLT2 inhibitors . Diabetic cardiomyopathy . Diabetes . Biomarkers . Echocardiography
Introduction Great interest of scientific and professional community is provoked when the unexpected beneficial effects of certain drug occur, especially on entities that are epidemiologically very significant as type 2 diabetes.
* Petra Grubić Rotkvić [email protected] 1
Department of Cardiology, University Hospital “Sveti Duh”, Zagreb, Croatia
2
Department of Endocrinology, Diabetes, and Metabolism, University Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia
3
Department for Medicine of Sports and Exercise, Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
4
Department of Cardiology, University Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia
5
Department of Cardiology, Magdalena Clinic for Cardiovascular Disease, Krapinske Toplice, Croatia
This is currently emerging with sodium-glucose cotransporter 2 (SGLT2) inhibitors that have also reminded us of the neglected but common entity of diabetic cardiomyopathy, which is p
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