Table of Contents

ABSTRACT

Clinical studies indicate that compared with intensive treatment of glycemia, cardiovascular benefits can occur more efficiently via reducing LDL-cholesterol and blood pressure. There may be substantial declines in heart failure (HF) hospitalization and deaths due to CVDs, compared to any beneficial effect on risk of stroke and myocardial infarction (MI) on treatment of diabetes mellitus (T2DM) with SGLT2 inhibitors. Sotagliflozin reduced the rate of all-cause stroke by 34% (Hazard Ratio [HR]: 0.66; P = 0.012), with 1.2 events per 100 patient-years in the sotagliflozin group and 1.8 events per 100 patient-years in the placebo group. SGLT2 inhibition has been demonstrated to be protective with cardio-renal benefits in various disease states, such as T2DM, chronic kidney disease (CKD), and HF. Acute MI (AMI) patients may have better echo-cardiographic results for both structural and functional metrics, such as left ventricular dysfunction. Interestingly, in studies when empagliflozin was administered in early stage of AMI, it showed a significantly larger median NT-proBNP decline compared to placebo. In a clinical study, among AMI patients (n = 476) who were randomized to receive empagliflozin (10 mg daily) or placebo within 72 h of angioplasty, the results showed that early initiation of empagliflozin on top of guideline-recommended post-AMI therapy, may cause a greater decline in NT-pro-BNP levels compared with placebo. The empagliflozin group also found significant improvements in functional and structural echo-cardiographic parameters, with a significant increase of LVEF observed as early as 6 weeks of follow-up. The benefits of SGLT inhibition outweigh the risks in the post-MI care. It is proposed that benefits may be further increased by using a combination of sotaglifozin and empagliflozin.

Keywords: Diabetes, glycaemia, heart failure, blood pressure, gliflozins