Thread by @accpcardprn

TEACHING TUESDAY ALERT!
Thanks, @chfpharmd !

SGLT-2 Inhibitors have quickly become one of the most talked-about pharmacotherapeutic classes in medicine. Let’s take a step back and understand how we got to this point and how you can use these agents in practice.

We can thank the -flozins for all of the wonderful data we now have with antihyperglycemic and their role in the prevention and treatment of CV disease. Since 2008, the FDA now requires cardiovascular outcomes trials based on these agents being linked to undesirable CV outcomes.

Cardiovascular disease is a global epidemic. Prevention is key. But we also need therapeutics for preventing recurrent CV disease as well.

Diabetes and CV disease are inextricably linked. DM induces inflammation in coronary arteries, leading to ASCVD. HF can be a direct result of this. DM also enhances LV hypertrophy, playing a role in HFpEF.

There are four large CVOTs that assessed the SGLT2Is in patients with ASCVD and DM. Of note, only Empagliflozin and Canagliflozin demonstrated superiority to placebo for MACE. However, HF hospitalizations were reduced by all four drugs.

These CVOTs set the stage for DAPA-HF and EMPEROR-Reduced. Both trials demonstrated an overall reduction in the composite of CV death and HF hospitalization in HFrEF patients with or without diabetes mellitus.

The 2021 HF guidelines now recommend SGLT2I be considered after ARNi and BB are initiated, in patients with ACC/AHA Stage C HFrEF (NYHA II-IV), without preference for Dapagliflozin or Empagliflozin.

How about patients with ASCVD or CKD? Take a look below and follow this useful algorithm that also incorporates the GLP-1 receptor agonists.. Ultimately, there are MANY patients that can benefit from these therapies!

We have more SGLT2i data on the way as well. Most notably, in the HFpEF space. Stay tuned! 2021 may have some exciting news.