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Should cardiologists prescribe SGLT2 Inhibitor routinely to all

Should cardiologists prescribe SGLT2 Inhibitor routinely to all

SGLT2 inhibitors are introduced primarily as glucose-lowering drugs but the new analysis of DECLARE-TIMI 58 trial gave startling revelations that SGLT2 inhibitors reduced both atherosclerotic cardiovascular disease as well as heart failure outcomes in diabetic patients. Whether this drug is also useful in non-diabetic patients with ASCVD risk and heart failure risk is a matter of future research.

Two previous trials with SGLT2 inhibitors and diabetes — EMPAREG Outcomes with empagliflozin and CANVAS have also proved that these drugs empagliflozin, canagliflozin created pronounced benefits among patients with prior myocardial infarction and preserved ejection were the subjects of new analysis reported in DECLARE-TIMI 58 trial using dapagliflozin.

It reminds us of the introduction of statins in early 2000 when it was introduced as a lipid-lowering drug and later on the membrane stabilization impact of the drug was overwhelming. Dapagliflozin primarily introduced as glucose lowering drug is found to be very effective in ASCVD as well as heart failure outcomes.

It is been suggested that since diabetes has got a profound impact on the inflammatory milieu it causes severe inflammatory disease adversely impacting on the pump of the circulation (heart) causing heart failure, pipes of the circulation that are vessels (causing atherosclerosis) and the filter called diabetic nephropathy.

Use of SGLT2 inhibitor is impacting all three of them and should be considered strongly as a part of the routine secondary prevention to induce ischemic events, heart failure, and renal events.

What is most exciting that these effects are acting via glucose independent mechanism and absolute risk reduction in post-MI patients is similar in diabetic and nondiabetic populations and additive to what is observed with antiplatelet therapy and intensive statin therapy.

It is a very intriguing thought that a cardiologist is finding an antidiabetic drug as a major drug into its list of secondary prevention drugs. Whether this drug is active only in diabetic patients in benefiting with cardiovascular outcomes or also in non-diabetic patients is also a matter of research for the future.

About SGLT2 Inhibitors 

Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors are a class of prescription medicines FDA approved in 2013 for lowering blood sugar in adults with type 2 diabetes. They work by causing the kidneys to remove sugar from the body through the urine. Approved drugs in the SGLT2 inhibitor class include canagliflozin, dapagliflozin, and empagliflozin.

Disclaimer: The views expressed in the above article are solely those of the author/agency in his/her private capacity and DO NOT represent the views of Speciality Medical Dialogues.
Source: self

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  1. Any study of comparison between the three SGLT2 inhibitors in terms of efficacy ?

  2. user
    Dr Ishwar Chandra Manjhi April 14, 2019, 12:01 pm

    SGLT2 is best antidiabetic oral medication as of now togather with help in preventing cardiovascular events in the long run

  3. user
    Dr.Pramod Kumar Sharma April 12, 2019, 12:22 pm

    Good suggestion for further discussion.

  4. These drugs are compared with placebo. It would be better to compare them in non interiority or superiority trial against standard heart failure treatment or cad treatment. Practically these drugs are neither good in Glucose loweing nor in heart failure prevention. Most people get urinary tract infection with these drugs.

  5. user
    Dr.A.K.Baliarsinha April 11, 2019, 7:20 pm

    Pleotropic effect and anti inflammatory properties of SGLT 2 inhibitors to be established before being used clinically in non diabetic subjects.