Author + information
- Received October 2, 2019
- Revision received November 15, 2019
- Accepted November 17, 2019
- Published online January 27, 2020.
- TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, and Department of Medicine, Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Eugene Braunwald, TIMI Study Group, Brigham and Women’s Hospital, 60 Fenwood Road, 7th Floor, Boston, Massachusetts 02115.
• T2DM, HF, and CKD are closely intertwined.
• SGLT2i exert pleiotropic metabolic and direct cardioprotective and nephroprotective effects.
• SGLT2i reduce inflammation, oxidative stress, fibrosis, intraglomerular hypertension, and sympathetic nervous system activation, and may improve mitochondrial function and myocardial efficiency.
• Cardiologists, diabetologists, nephrologists, and primary care physicians should be familiar with this drug class.
Sodium-glucose cotransporter 2 inhibitors (SGLT2i), a new drug class approved for treatment of diabetes, have been shown to possess a favorable metabolic profile and to significantly reduce atherosclerotic events, hospitalization for heart failure, cardiovascular and total mortality, and progression of chronic kidney disease. Although initially considered to be only glucose-lowering agents, the effects of SGLT2i have expanded far beyond that, and their use is now being studied in the treatment of heart failure and chronic kidney disease, even in patients without diabetes. It is therefore critical for cardiologists, diabetologists, nephrologists, and primary care physicians to be familiar with this drug class. This first part of this 2-part review provides an overview of the current understanding of the mechanisms of the cardio-metabolic-renal benefits of SGLT2i. The second part summarizes the recent clinical trials of SGLT2i.
Dr. Zelniker is currently affiliated with the Division of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria. Dr. Zelniker is supported by the German Research Foundation (Deutsche Forschungsgemeinschaft ZE 1109/1-1); and has received lecture fees from AstraZeneca. Dr. Braunwald has received research grants through his institution from AstraZeneca, Daiichi-Sankyo, GlaxoSmithKline, Merck, and Novartis; has consultancies with Amgen, Cardurion, MyoKardia, NovoNordisk, and Verve; has received personal fees for lectures from Medscape; and has performed uncompensated consultancies and lectures for Novartis and The Medicines Company.
- Received October 2, 2019.
- Revision received November 15, 2019.
- Accepted November 17, 2019.
- 2020 American College of Cardiology Foundation
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