Title:Sodium-Glucose Cotransporter Inhibitors in Non- Diabetic Heart Failure: A Narrative Review
VOLUME: 21
Author(s):Ranjan Dahal*, Yogesh Acharya and Debabrata Mukherjee
Affiliation:Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, EL Paso, Texas;, Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway,, Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, EL Paso, Texas;
Keywords:Sodium-glucose transporter 2 inhibitors, SGLT-2 inhibitors, dapagliflozin, type 2 diabetes mellitus, congestive
heart failure, systolic heart failure, disease management
Abstract:Background: Heart failure (HF) is one of the leading public health problems with a substantial burden in the
global healthcare system. Although significant efforts are based on prevention, early recognition, and proper management of
HF, the worldwide surge of risk factors like hypertension, diabetes, obesity has further complicated the existing problem.
Objective: To define the role of the sodium-glucose cotransporter 2 (SGLT2) inhibitors in non-diabetic HF.
Methods: We performed a comprehensive literature review to examine the available evidence in the clinical implications of
SGLT2 inhibitors in non-diabetic HF using the online databases (PubMed and Embase).
Results: We identified two RCTs - DAPA-HF and DEFINE-HF, which were conducted to analyze the net clinical benefit of
dapagliflozin in non-diabetic HF patients. Although we could not study the composite effects of these studies due to the difference
in outcome measures, the individual outcomes look promising. The number needed to treat (NNT) to prevent one
primary event was 21 (95% CI: 15 to 38) in the DAPA study. In, DEFINE HF study, responder analysis showed a significant
proportion of patients in the treatment arm experienced improvements in functional status with clinically meaningful
improvement in KCCQ-OS by 3.7 points and KCCQ-CS by 4.6 points with NNT of 10 and 7 respectively, at 12 weeks.
Both studies also showed low safety concerns in patients without T2D.
Conclusions: The outcomes of the two RCTs, DAPA-HF and DEFINE-HF, that studied the effects of SGLT2 inhibitors in
non-diabetic HF showed promising clinical outcomes. Although we are waiting for other prospective RCTs to reflect similar
results and safety profiles, it seems the SGLT2 inhibitors can have broader clinical implications in managing non-diabetic
HF with improved cardiovascular outcomes.
