SGLT2 inhibitors and new frontiers in heart failure treatment regardless of ejection fraction and setting DOI Creative Commons
Anna Merlo, Emilia D’Elia, Luca Di Odoardo

et al.

European Heart Journal Supplements, Journal Year: 2024, Volume and Issue: 27(Supplement_1), P. i137 - i140

Published: Dec. 22, 2024

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been shown to reduce cardiovascular (CV) mortality and heart failure (HF) hospitalizations, independently from left ventricular ejection fraction (EF). Their efficacy has assessed both in patients with reduced preserved EF, notable benefits renal outcomes as well. The initiation of SGLT2i the early phase hospitalization for acute HF proven be safe beneficial. EMPULSE DICTATE-AHF trials support empagliflozin dapagliflozin use, respectively, reducing worsening events, improving quality life, enhancing diuretic efficiency. Notably, these emerge shortly after therapy, underscoring importance integration into guideline-directed medical therapy (GDMT). Despite concerns regarding deterioration function, appear even low estimated glomerular filtration rates (eGFR). Data suggest that persist without increased safety risks, reassuring clinicians their experiencing decline. Concerns about volume depletion induced by also addressed, documented enhanced diuresis adverse impacts. Moreover, associated a lower risk hyperkalaemia thus allowing better optimization GDMT, including use mineralocorticoid receptor antagonists. Overall, findings highlight broad CV, renal, metabolic SGLT2i, advocating widespread management, regardless EF or eGFR.

Language: Английский

Integrated Management of Cardiovascular–Renal–Hepatic–Metabolic Syndrome: Expanding Roles of SGLT2is, GLP-1RAs, and GIP/GLP-1-RAs DOI Creative Commons
Nikolaos Theodorakis, Maria Nikolaou

Biomedicines, Journal Year: 2025, Volume and Issue: 13(1), P. 135 - 135

Published: Jan. 8, 2025

Cardiovascular-Kidney-Metabolic syndrome, introduced by the American Heart Association in 2023, represents a complex and interconnected spectrum of diseases driven shared pathophysiological mechanisms. However, this framework notably excludes liver-an organ fundamental to metabolic regulation. Building on concept, Cardiovascular-Renal-Hepatic-Metabolic (CRHM) syndrome incorporates liver's pivotal role disease spectrum, particularly through its involvement via dysfunction-associated steatotic liver (MASLD). Despite increasing prevalence CRHM unified management strategies remain insufficiently explored. This review addresses following critical question: How can novel anti-diabetic agents, including sodium-glucose cotransporter-2 inhibitors (SGLT2is), glucagon-like peptide-1 receptor agonists (GLP-1RAs), dual gastric inhibitory polypeptide (GIP)/GLP-1RA, offer an integrated approach managing beyond boundaries traditional specialties? By synthesizing evidence from landmark clinical trials, we highlight paradigm-shifting potential these therapies. SGLT2is, such as dapagliflozin empagliflozin, have emerged cornerstone guideline-directed treatments for heart failure (HF) chronic kidney (CKD), providing benefits that extend glycemic control are independent diabetes status. GLP-1RAs, e.g., semaglutide, transformed obesity enabling weight reductions exceeding 15% improving outcomes atherosclerotic cardiovascular (ASCVD), diabetic CKD, HF, MASLD. Additionally, tirzepatide, GIP/GLP-1RA, enables unprecedented loss (>20%), reduces risk over 90%, improves HF with preserved ejection fraction (HFpEF), MASLD, obstructive sleep apnea. moving organ-specific approach, propose integrates agents into holistic syndrome. paradigm shift moves away fragmented, organ-centric toward more fostering collaboration across specialties marking progress precision cardiometabolic medicine.

Language: Английский

Citations

6
Evaluating the overall renal outcomes of sodium-glucose cotransporter-2 (SGLT2) inhibitors in patients with chronic kidney disease (CKD) DOI Creative Commons

Min-Jia Cao,

Tingting Liang,

Li Xu

et al.

Diabetology & Metabolic Syndrome, Journal Year: 2025, Volume and Issue: 17(1)

Published: Jan. 6, 2025

Our meta-analysis fills gaps by assessing sodium-glucose cotransporter-2 (SGLT2) inhibitors' renal outcomes in chronic kidney disease (CKD) patients including long-term effects and the subgroup analyses of estimated glomerular filtration rate (eGFR) values follow-up times. The literature search relevant randomized controlled trials (RCTs) was conducted Medline, Embase, Cochrane Central from inception to 8 June 2023 on with CKD treated SGLT2 inhibitors. We selected medical subject heading (MeSH) terms free text associated gliflozin RCT. calculated odds ratio (OR) or harzard 95% confidence intervals (CIs) for composite dichotomous data, weighted mean differences (WMD) changes eGFR. 16 RCTs enrolling 52,306 were final population, 26,910 being inhibitors 25,396 serving as controls identified. found that there no decline change eGFR after 13 weeks treatment significantly improved 64 (64–104 weeks: WMD, 1.024 mL/min/1.73m2/per year, CI 0.643–1.406; 104 0.978, 0.163–1.794).SGLT2 reduced risk acute injury (AKI) (OR 0.836; 0.747–0.936; I2 = 0%), mainly derived empagliflozin (P 0.001) increased incidence volume-related adverse events (AEs) 23%.However, statically observed death due 0.182) < 15 mL/min/1.73 m2 0.202). results our showed treatment, a significant benefit further improvement slighter lower values. Additionally, reduce AKI when using empagliflozin, while is an AEs exclusively stage 2 CKD. Trial registration CRD42023437061. latest guidelines endocrinology advocated use potential beneficial kidney. However, initial decline(dip) little data evaluating disparate stages serve deterring factors clinicians Different other meta-analyses, we follow up duration more than Further, progression outcomes, but statistically sustained eGFR<15 m2. Moreover, safety indicate

Language: Английский

Citations

1
Mitochondria and the Repurposing of Diabetes Drugs for Off-Label Health Benefits DOI Open Access
Joyce Yip, Grace Shu Hui Chiang,

I Lee

et al.

International Journal of Molecular Sciences, Journal Year: 2025, Volume and Issue: 26(1), P. 364 - 364

Published: Jan. 3, 2025

This review describes our current understanding of the role mitochondria in repurposing anti-diabetes drugs metformin, gliclazide, GLP-1 receptor agonists, and SGLT2 inhibitors for additional clinical benefits regarding unhealthy aging, long COVID, mental neurogenerative disorders, obesity. Metformin, most prominent these diabetes drugs, has been called “Drug Miracles Wonders,” as trials have found it to be beneficial human patients suffering from maladies. To promote viral replication all infected cells, SARS-CoV-2 stimulates liver cells produce glucose export into blood stream, which can cause COVID patients, reduces levels blood, was shown cut incidence rate half recovering SARS-CoV-2. Metformin leads phosphorylation AMP-activated protein kinase AMPK, accelerates import via transporter GLUT4 switches starvation mode, counteracting virus. Diabetes also stimulate unfolded response thus mitophagy, is healthy aging health. were mimic exercise help reduce body weight.

Language: Английский

Citations

0
Sodium–Glucose Cotransporter 2 Inhibitors as Potential Antioxidant Therapeutic Agents in Cardiovascular and Renal Diseases DOI Creative Commons
Tapan Patel, Hong Zheng, Kaushik P. Patel

et al.

Antioxidants, Journal Year: 2025, Volume and Issue: 14(3), P. 336 - 336

Published: March 13, 2025

Redox (reduction-oxidation) imbalance is a physiological feature regulated by well-maintained equilibrium between reactive oxygen species (ROS) and oxidative stress (OS), the defense system of body (antioxidant enzymes). The redox comprises levels ROS in cells, tissues overall organ system. are synchronized gradients electrons that generated due to sequential reduction oxidation various biomolecules enzymes. Such reactions present each cell, irrespective any tissue or organ. Failure such coordinated regulation leads production excessive free radicals. Excessively produced radicals affect cellular molecular processes required for cell survival growth, leading pathophysiological conditions and, ultimately, failure. Overproduction key factors involved onset progression associated with cardiovascular renal diseases. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) glucose-lowering drugs prescribed diabetic patients. Interestingly, apart from their effect, these exhibit beneficial effects non-diabetic patients suffering chronic kidney diseases, perhaps antioxidant properties. Recently, it has been demonstrated SGLT2is strong properties reducing OS. Hence, this review, we aim novel role consequent disease states.

Language: Английский

Citations

0
SGLT2 inhibitors and new frontiers in heart failure treatment regardless of ejection fraction and setting DOI Creative Commons
Anna Merlo, Emilia D’Elia, Luca Di Odoardo

et al.

European Heart Journal Supplements, Journal Year: 2024, Volume and Issue: 27(Supplement_1), P. i137 - i140

Published: Dec. 22, 2024

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been shown to reduce cardiovascular (CV) mortality and heart failure (HF) hospitalizations, independently from left ventricular ejection fraction (EF). Their efficacy has assessed both in patients with reduced preserved EF, notable benefits renal outcomes as well. The initiation of SGLT2i the early phase hospitalization for acute HF proven be safe beneficial. EMPULSE DICTATE-AHF trials support empagliflozin dapagliflozin use, respectively, reducing worsening events, improving quality life, enhancing diuretic efficiency. Notably, these emerge shortly after therapy, underscoring importance integration into guideline-directed medical therapy (GDMT). Despite concerns regarding deterioration function, appear even low estimated glomerular filtration rates (eGFR). Data suggest that persist without increased safety risks, reassuring clinicians their experiencing decline. Concerns about volume depletion induced by also addressed, documented enhanced diuresis adverse impacts. Moreover, associated a lower risk hyperkalaemia thus allowing better optimization GDMT, including use mineralocorticoid receptor antagonists. Overall, findings highlight broad CV, renal, metabolic SGLT2i, advocating widespread management, regardless EF or eGFR.

Language: Английский

Citations

0