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Compiled and organized by Yimaitong, please do not reprint without authorization
.
Obesity, diabetes, and cardiovascular complications of diabetes remain major challenges facing the current global healthcare system
.
Recently, the European Heart Journal (IF: 29.
983), an authoritative journal in the cardiovascular field, reviewed and sorted out the research progress/guideline updates on "diabetes", "metabolic disorders" and "cardiovascular" in 2021.
Keywords/core Contents include "obesity, glucagon-like peptide 1 receptor agonist (GLP-1RA), sodium-glucose co-transporter 2 inhibitor (SGLT-2i), recommendations for the classification and prevention of cardiovascular disease (including type 2 diabetes)", etc.
.
Review 2021: Exploring Obesity Treatment Strategies Obesity, a chronic disease prone to rebound, has become a global public health challenge
.
Weight loss, which is often difficult to maintain through life>
.
Diabetes and obesity are “mutually complementary”, and the simultaneous and continuous increase in the prevalence of both worldwide has caused widespread concern and exploration of countermeasures, such as the NDPS and STEP 1 studies
.
➤NDPS trial: mean follow-up of 24.
7 months, demonstrated that this low-cost primary care program for weight loss through "physical activity + reduction in total and saturated fat intake" nearly halved the risk of T2D in prediabetic patients , improvement persisted for at least 2 years, and 1 in 11 participants prevented T2D
.
➤STEP series studies: STEP1, together with STEP 2, 3, and 4 test results, confirmed the significant effect of glucagon-like peptide 1 receptor agonist (GLP-1RA) semaglutide in obese/overweight adults in terms of weight loss Benefit is also the first time in nearly 20 years
.
More than half of the people in the semaglutide group lost at least 15% of their body weight, and despite the relatively short duration of the trial and the lack of bariatric surgery as a control, we may now have a method that can be compared with weight loss, at least in some overweight cases.
Surgery rivals medical options
.
Exploring cardiovascular effects: The CV benefit of the GLP-1 receptor agonist GLP-1 RA—reducing major cardiovascular events in T2D patients—has been demonstrated in several large cardiovascular outcome trials (CVOTs), but currently It is unclear what the benefit of GLP-1 RA is in the groups with "comorbid cardiovascular disease" and "combined cardiovascular risk factors"
.
Marsico et al published a meta-analysis of 7 large GLP-1 RA trials showing that these agents significantly reduced major adverse cardiovascular events (MACE), CV and total mortality, stroke and heart failure hospitalizations (HHF) incidence
.
However, the trend of myocardial infarction (MI) reduction in T2D patients was not significant
.
Of which: ➤ 12% reduction in 3P-MACE events, 73 NNTs required to prevent one event; ➤ 118 NNTs required to prevent one death; ➤ 300 NNTs required to prevent one admission for heart failure times
.
The study showed that the associated benefit of GLP-1RA was primarily driven by a reduction in arteriosclerosis-related events compared with SGLT2i
.
Five of the above trials included patients with "established cardiovascular disease" and "with risk factors for cardiovascular disease", and there was no significant difference in 3P-MACE between the two groups, confirming the effect of GLP-1 RA on patients at high CVD risk.
Equally beneficial
.
The above data support the relevant recommendations made by the 2019 ESC guidelines: GLP-1 RA is recommended for the treatment of patients with "T2D with CVD" and "T2D with multiple risk factors", which can bring CV benefit
.
Another GLP-1RA that has gained attention in the CV field is Efpeglenatide, similar to other GLP-1 RAs, in the AMPLITUDE-O trial, Efpeglenatide was shown to reduce the risk of CV events in patients with T2D and significantly reduce the composite kidney Incidence of outcomes (new-onset macroalbuminuria, increase in urine albumin/creatinine ratio ≥30% from baseline, sustained decrease in eGFR ≥40%, renal replacement therapy or persistent eGFR <15mL/min/1.
73m^2)
.
Importantly, the cardio-renal benefit of efpeglenatide was independent of baseline SGLT2i use and eGFR levels, justifying the combination of GLP-1RA + SGLT2i
.
Exploring cardiovascular effects: SGLT-2 inhibitors are a big year for SGLT2i, 2021
.
1.
Ertugliflozin and Heart Failure The VERTIS CV study evaluated the long-term effects of Ertugliflozin on CV and renal outcomes
.
This CV safety trial found 5 or 15 mg of Ertugliflozin compared to placebo in primary study objectives of time to first major adverse cardiovascular event, cardiovascular death, non-fatal myocardial infarction, in T2D patients with ASCVD or the composite endpoint of nonfatal stroke - achieved noninferiority (HR 0.
97, P<0.
001 for noninferiority)
.
Because VERTIS CV recruited a large number of participants with a history of HF and known pre-trial ejection fraction, we performed a between-group analysis for multiple HF-related prespecified outcomes
.
RESULTS: Ertugliflozin reduced first and overall HHF events compared with placebo, and the benefit of first HHF events was independent of HF history, ≤45% reduction in ejection fraction, or >45% preserved ejection fraction
.
The "delayed time to first HHF onset" benefit of Ertugliflozin was consistent across most baseline subgroups, and greater benefit was observed in the following three subgroups: eGFR < 60 mL/min/ 1.
73 m^2, proteinuria and use of diuretics
.
Other studies have also provided convincing evidence for the "HF benefit associated with SGLT2 inhibition
.
"
2.
Sotagliflozin and Heart Failure SOLOIST trial evaluated the effect of SGLT1/2 inhibitor Sotagliflozin in diabetic patients with acute decompensated heart failure
.
Studies have shown that in-hospital use of SGLT2i is safe after the patient's condition is stabilized, which is meaningful for patients to better adhere to treatment
.
More importantly, there was a significant reduction in total CV deaths, HHF, and urgent heart failure visits [HR 0.
67, relative risk reduction (RRR) 33%, absolute risk reduction (ARR) 25 cases/100 patient-years, P=0.
0009]
.
This benefit was seen very early and was statistically significant at 28 days
.
In the absence of contraindications, the SOLOIST data provide strong support for the initiation of SGLT2i therapy before hospital discharge in patients with diabetes and heart failure
.
Another analysis from the SOLOIST trial, which assessed a key patient-centric measure, days post-discharge survival (DAOH), showed significant improvements with DAOH, including a significant increase in survival days
.
And the "Kansas City Cardiomyopathy Questionnaire Score" used to measure patients' feelings, the Sotagliflozin group was significantly better than the placebo
.
Future trials will increasingly incorporate patient-centred outcomes
.
The SCORED trial compared sotagliflozin with placebo in patients with diabetes and chronic kidney disease
.
The study found that total cardiovascular mortality, heart failure hospitalizations, and urgent heart failure visits were significantly lower in the drug group (HR 0.
74, RRR 26%, ARR 1.
9/100 patient-years, P=0.
0004)
.
This trial extended the benefits of SGLT2i to diabetic patients with all levels of proteinuria (including microalbuminuria)
.
Notably, the total number of cardiovascular deaths, myocardial infarction, and stroke was also significantly reduced (previous SGLT2i trials had inconsistent results in reducing myocardial infarction, and none of the previous trials showed a significant reduction in stroke events)
.
In the SCORED study, was the drug's significant benefit on ischemia-related endpoints attributable to "inhibition of SGLT1 over SGLT2"? This requires further basic scientific research
.
3.
Overall CV/renal outcomes of SGLT2i Despite the importance of renal disease status for cardiovascular outcomes, in cardiology practice, T2D patients are rarely risk stratified based on renal parameters that do not exist in commonly used cardiovascular outcomes.
in the risk prediction scheme
.
The results of a prespecified exploratory analysis in VERTIS CV highlight the potential value of stratifying renal disease risk by UACR and renal function levels in predicting CV risk and hypothesized response to SGLT2i in T2D patients
.
A recent meta-analysis of 6 outcome trials evaluating overall CV and renal outcomes of SGLT2i drugs suggested that the greatest benefit was a reduction in HHF risk and renal disease progression, with HHF risk reduction being the most consistent across the trial observation results
.
4.
SGLT2i and heart failure with reduced ejection fraction Some scholars have conducted special HF related trials for heart failure patients with reduced ejection fraction (HFrEF)
.
DAPA-HF and EMPEROR-Reduced clearly demonstrated the benefit of SGLT2i on HFrEF
.
An in-depth analysis of the DAPA-HF data by stratifying diabetic and non-diabetic patients observed a consistent benefit (HR 0.
73 in non-diabetic patients and 0.
75 in diabetic patients; P for interaction = 0.
80) , the safety is good
.
Another subgroup analysis of EMPEROR-Reduced assessed whether the beneficial effects of Empagliflozin on CV and renal endpoints differed between diabetic and nondiabetic patients
.
showed that the CV and renal benefits in HFrEF patients were independent of baseline diabetes status and were present at all HbA1c levels
.
Previously, some physicians were very concerned about prescribing SGLT2i to non-diabetic patients, but in fact the risk of hypoglycemia and diabetic ketoacidosis was low
.
5.
SGLT2i and cardiac hypertrophy Brown et al conducted a very interesting clinical study to assess whether dapagliflozin could reverse left ventricular hypertrophy in T2D patients
.
In this randomized study, dapagliflozin significantly reduced left ventricular mass (LVM) as assessed by cardiac MRI after 12 months of treatment in 66 patients with T2D compared with placebo
.
The reduction in LVM was accompanied by a reduction in systolic blood pressure, body weight, visceral and subcutaneous adipose tissue, insulin resistance, and hsCRP
.
6.
The risk of amputation nearly doubled with canagliflozin in the SGLT2i and amputation CANVAS trial, which is troubling, despite the results of the CREDENCE trial of dapagliflozin, empagliflozin, and Ertugliflozin in the canagliflozin trial This signal was absent in the study, but concerns about SGLT2 inhibition and an increased risk of amputation persist
.
Presumably, in the SGLT2 inhibitor trials reported after CANVAS, there was no increased risk of amputation because researchers were asked to focus more on lower extremity care
.
Using real-world data from more than 3 million T2D patients in the United States, Paul et al provide reassuring data that the risk of lower limb amputation with SGLT2 inhibitors is no greater than with other antihyperglycemic agents
.
The fact that "history of peripheral arterial disease" was the most likely factor leading to amputation underscored the importance of timely and optimal T2D management to avoid the development and progression of peripheral arterial disease
.
7.
Other progress In SUGAR-DM-HF, empagliflozin can significantly reduce ejection fraction and lower left ventricular volume in patients with heart failure complicated with T2D or prediabetes
.
These observations are consistent with findings from similar studies in different patient types that point to reversal of cardiac remodeling as the source of the SGLT2 inhibitor-mediated reduction in HHF observed in the EMPEROR-Reduced and DAPA-HF trials
.
The EMPERIAL trial evaluated the effect of empagliflozin on exercise capacity and patient-reported outcomes in HFrEF and HFpEF patients with and without T2D
.
312 patients with HFrEF and 315 patients with HFpEF were randomized to 10 mg empagliflozin or placebo for 12 weeks, with the primary endpoint being change in 6-minute walk test distance at week 12
.
In this trial, the primary outcome for both patient populations was neutral
.
Exploratory prespecified analyses of KCCQ-TSS response rates, hyperemia scores, and diuretic use demonstrated benefit in SGLT2i-treated patients, leading to the hypothesis that SGLT2i treatment might have an effect on these factors
.
Interestingly, recent analyses from DAPA-HF and DELESS showed improved health in SGLT2i-treated patients as assessed by KCCQ
.
The EMPEROR-PRESERVED trial, which evaluated both diabetic and nondiabetic patients with HFpEF, found a significant reduction in either CV death or HHF (HR 0.
79, RRR 21%, ARR 3.
3%, P<0.
001)
.
The trial confirmed the findings of SOLOIST and Score, each showing significant benefit in a subgroup of patients with HFpEF
.
EMPEROR-PRESERVED expands on these findings by demonstrating benefits for non-diabetic patients as well
.
The "2021 ESC Cardiovascular Disease Prevention Clinical Practice Guidelines" update the "2021 ESC Cardiovascular Disease Prevention Clinical Practice Guidelines" recommends that for the basic healthy population, patients with ASCVD, and patients with type 2 diabetes, risk stratification and treatment selection should be adopted.
Step-by-step" management strategy: ➤ First step: refer to recommendations that apply to all subjects; ➤ Second step: propose "10-year CV risk, lifetime CV risk, treatment benefit, comorbidities, and patient preferences" ” of intensive prevention and treatment goals (Figure 1)
.
Note: ASCVD atherosclerotic cardiovascular disease; CKD chronic kidney disease; DN diabetes; FH familial hypercholesterolemia; TOD, target organ damage Treatment Guidelines Update "2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure" recommends: For patients with HFrEF, regardless of diabetes status, SGLT2i dapagliflozin or empagliflozin (IA) is recommended in addition to optimal treatment drugs
.
Dapagliflozin or empagliflozin in combination with ACE-I/ARNI, beta-blockers, and MRAs reduced the risk of CV death and HF worsening in patients with HFrEF
.
On the premise of ensuring medication safety, these four core drugs should be used as soon as possible
.
Table 1 Drug therapy for patients with YHA grade II-IV heart failure with reduced ejection fraction (left ventricular ejection fraction ≤40%) in cardiovascular medicine 2021: diabetes and metabolic disorders, European Heart Journal, 2022;, ehab876, https://doi.
org/10.
1093/eurheartj/ehab876
.
Obesity, diabetes, and cardiovascular complications of diabetes remain major challenges facing the current global healthcare system
.
Recently, the European Heart Journal (IF: 29.
983), an authoritative journal in the cardiovascular field, reviewed and sorted out the research progress/guideline updates on "diabetes", "metabolic disorders" and "cardiovascular" in 2021.
Keywords/core Contents include "obesity, glucagon-like peptide 1 receptor agonist (GLP-1RA), sodium-glucose co-transporter 2 inhibitor (SGLT-2i), recommendations for the classification and prevention of cardiovascular disease (including type 2 diabetes)", etc.
.
Review 2021: Exploring Obesity Treatment Strategies Obesity, a chronic disease prone to rebound, has become a global public health challenge
.
Weight loss, which is often difficult to maintain through life>
.
Diabetes and obesity are “mutually complementary”, and the simultaneous and continuous increase in the prevalence of both worldwide has caused widespread concern and exploration of countermeasures, such as the NDPS and STEP 1 studies
.
➤NDPS trial: mean follow-up of 24.
7 months, demonstrated that this low-cost primary care program for weight loss through "physical activity + reduction in total and saturated fat intake" nearly halved the risk of T2D in prediabetic patients , improvement persisted for at least 2 years, and 1 in 11 participants prevented T2D
.
➤STEP series studies: STEP1, together with STEP 2, 3, and 4 test results, confirmed the significant effect of glucagon-like peptide 1 receptor agonist (GLP-1RA) semaglutide in obese/overweight adults in terms of weight loss Benefit is also the first time in nearly 20 years
.
More than half of the people in the semaglutide group lost at least 15% of their body weight, and despite the relatively short duration of the trial and the lack of bariatric surgery as a control, we may now have a method that can be compared with weight loss, at least in some overweight cases.
Surgery rivals medical options
.
Exploring cardiovascular effects: The CV benefit of the GLP-1 receptor agonist GLP-1 RA—reducing major cardiovascular events in T2D patients—has been demonstrated in several large cardiovascular outcome trials (CVOTs), but currently It is unclear what the benefit of GLP-1 RA is in the groups with "comorbid cardiovascular disease" and "combined cardiovascular risk factors"
.
Marsico et al published a meta-analysis of 7 large GLP-1 RA trials showing that these agents significantly reduced major adverse cardiovascular events (MACE), CV and total mortality, stroke and heart failure hospitalizations (HHF) incidence
.
However, the trend of myocardial infarction (MI) reduction in T2D patients was not significant
.
Of which: ➤ 12% reduction in 3P-MACE events, 73 NNTs required to prevent one event; ➤ 118 NNTs required to prevent one death; ➤ 300 NNTs required to prevent one admission for heart failure times
.
The study showed that the associated benefit of GLP-1RA was primarily driven by a reduction in arteriosclerosis-related events compared with SGLT2i
.
Five of the above trials included patients with "established cardiovascular disease" and "with risk factors for cardiovascular disease", and there was no significant difference in 3P-MACE between the two groups, confirming the effect of GLP-1 RA on patients at high CVD risk.
Equally beneficial
.
The above data support the relevant recommendations made by the 2019 ESC guidelines: GLP-1 RA is recommended for the treatment of patients with "T2D with CVD" and "T2D with multiple risk factors", which can bring CV benefit
.
Another GLP-1RA that has gained attention in the CV field is Efpeglenatide, similar to other GLP-1 RAs, in the AMPLITUDE-O trial, Efpeglenatide was shown to reduce the risk of CV events in patients with T2D and significantly reduce the composite kidney Incidence of outcomes (new-onset macroalbuminuria, increase in urine albumin/creatinine ratio ≥30% from baseline, sustained decrease in eGFR ≥40%, renal replacement therapy or persistent eGFR <15mL/min/1.
73m^2)
.
Importantly, the cardio-renal benefit of efpeglenatide was independent of baseline SGLT2i use and eGFR levels, justifying the combination of GLP-1RA + SGLT2i
.
Exploring cardiovascular effects: SGLT-2 inhibitors are a big year for SGLT2i, 2021
.
1.
Ertugliflozin and Heart Failure The VERTIS CV study evaluated the long-term effects of Ertugliflozin on CV and renal outcomes
.
This CV safety trial found 5 or 15 mg of Ertugliflozin compared to placebo in primary study objectives of time to first major adverse cardiovascular event, cardiovascular death, non-fatal myocardial infarction, in T2D patients with ASCVD or the composite endpoint of nonfatal stroke - achieved noninferiority (HR 0.
97, P<0.
001 for noninferiority)
.
Because VERTIS CV recruited a large number of participants with a history of HF and known pre-trial ejection fraction, we performed a between-group analysis for multiple HF-related prespecified outcomes
.
RESULTS: Ertugliflozin reduced first and overall HHF events compared with placebo, and the benefit of first HHF events was independent of HF history, ≤45% reduction in ejection fraction, or >45% preserved ejection fraction
.
The "delayed time to first HHF onset" benefit of Ertugliflozin was consistent across most baseline subgroups, and greater benefit was observed in the following three subgroups: eGFR < 60 mL/min/ 1.
73 m^2, proteinuria and use of diuretics
.
Other studies have also provided convincing evidence for the "HF benefit associated with SGLT2 inhibition
.
"
2.
Sotagliflozin and Heart Failure SOLOIST trial evaluated the effect of SGLT1/2 inhibitor Sotagliflozin in diabetic patients with acute decompensated heart failure
.
Studies have shown that in-hospital use of SGLT2i is safe after the patient's condition is stabilized, which is meaningful for patients to better adhere to treatment
.
More importantly, there was a significant reduction in total CV deaths, HHF, and urgent heart failure visits [HR 0.
67, relative risk reduction (RRR) 33%, absolute risk reduction (ARR) 25 cases/100 patient-years, P=0.
0009]
.
This benefit was seen very early and was statistically significant at 28 days
.
In the absence of contraindications, the SOLOIST data provide strong support for the initiation of SGLT2i therapy before hospital discharge in patients with diabetes and heart failure
.
Another analysis from the SOLOIST trial, which assessed a key patient-centric measure, days post-discharge survival (DAOH), showed significant improvements with DAOH, including a significant increase in survival days
.
And the "Kansas City Cardiomyopathy Questionnaire Score" used to measure patients' feelings, the Sotagliflozin group was significantly better than the placebo
.
Future trials will increasingly incorporate patient-centred outcomes
.
The SCORED trial compared sotagliflozin with placebo in patients with diabetes and chronic kidney disease
.
The study found that total cardiovascular mortality, heart failure hospitalizations, and urgent heart failure visits were significantly lower in the drug group (HR 0.
74, RRR 26%, ARR 1.
9/100 patient-years, P=0.
0004)
.
This trial extended the benefits of SGLT2i to diabetic patients with all levels of proteinuria (including microalbuminuria)
.
Notably, the total number of cardiovascular deaths, myocardial infarction, and stroke was also significantly reduced (previous SGLT2i trials had inconsistent results in reducing myocardial infarction, and none of the previous trials showed a significant reduction in stroke events)
.
In the SCORED study, was the drug's significant benefit on ischemia-related endpoints attributable to "inhibition of SGLT1 over SGLT2"? This requires further basic scientific research
.
3.
Overall CV/renal outcomes of SGLT2i Despite the importance of renal disease status for cardiovascular outcomes, in cardiology practice, T2D patients are rarely risk stratified based on renal parameters that do not exist in commonly used cardiovascular outcomes.
in the risk prediction scheme
.
The results of a prespecified exploratory analysis in VERTIS CV highlight the potential value of stratifying renal disease risk by UACR and renal function levels in predicting CV risk and hypothesized response to SGLT2i in T2D patients
.
A recent meta-analysis of 6 outcome trials evaluating overall CV and renal outcomes of SGLT2i drugs suggested that the greatest benefit was a reduction in HHF risk and renal disease progression, with HHF risk reduction being the most consistent across the trial observation results
.
4.
SGLT2i and heart failure with reduced ejection fraction Some scholars have conducted special HF related trials for heart failure patients with reduced ejection fraction (HFrEF)
.
DAPA-HF and EMPEROR-Reduced clearly demonstrated the benefit of SGLT2i on HFrEF
.
An in-depth analysis of the DAPA-HF data by stratifying diabetic and non-diabetic patients observed a consistent benefit (HR 0.
73 in non-diabetic patients and 0.
75 in diabetic patients; P for interaction = 0.
80) , the safety is good
.
Another subgroup analysis of EMPEROR-Reduced assessed whether the beneficial effects of Empagliflozin on CV and renal endpoints differed between diabetic and nondiabetic patients
.
showed that the CV and renal benefits in HFrEF patients were independent of baseline diabetes status and were present at all HbA1c levels
.
Previously, some physicians were very concerned about prescribing SGLT2i to non-diabetic patients, but in fact the risk of hypoglycemia and diabetic ketoacidosis was low
.
5.
SGLT2i and cardiac hypertrophy Brown et al conducted a very interesting clinical study to assess whether dapagliflozin could reverse left ventricular hypertrophy in T2D patients
.
In this randomized study, dapagliflozin significantly reduced left ventricular mass (LVM) as assessed by cardiac MRI after 12 months of treatment in 66 patients with T2D compared with placebo
.
The reduction in LVM was accompanied by a reduction in systolic blood pressure, body weight, visceral and subcutaneous adipose tissue, insulin resistance, and hsCRP
.
6.
The risk of amputation nearly doubled with canagliflozin in the SGLT2i and amputation CANVAS trial, which is troubling, despite the results of the CREDENCE trial of dapagliflozin, empagliflozin, and Ertugliflozin in the canagliflozin trial This signal was absent in the study, but concerns about SGLT2 inhibition and an increased risk of amputation persist
.
Presumably, in the SGLT2 inhibitor trials reported after CANVAS, there was no increased risk of amputation because researchers were asked to focus more on lower extremity care
.
Using real-world data from more than 3 million T2D patients in the United States, Paul et al provide reassuring data that the risk of lower limb amputation with SGLT2 inhibitors is no greater than with other antihyperglycemic agents
.
The fact that "history of peripheral arterial disease" was the most likely factor leading to amputation underscored the importance of timely and optimal T2D management to avoid the development and progression of peripheral arterial disease
.
7.
Other progress In SUGAR-DM-HF, empagliflozin can significantly reduce ejection fraction and lower left ventricular volume in patients with heart failure complicated with T2D or prediabetes
.
These observations are consistent with findings from similar studies in different patient types that point to reversal of cardiac remodeling as the source of the SGLT2 inhibitor-mediated reduction in HHF observed in the EMPEROR-Reduced and DAPA-HF trials
.
The EMPERIAL trial evaluated the effect of empagliflozin on exercise capacity and patient-reported outcomes in HFrEF and HFpEF patients with and without T2D
.
312 patients with HFrEF and 315 patients with HFpEF were randomized to 10 mg empagliflozin or placebo for 12 weeks, with the primary endpoint being change in 6-minute walk test distance at week 12
.
In this trial, the primary outcome for both patient populations was neutral
.
Exploratory prespecified analyses of KCCQ-TSS response rates, hyperemia scores, and diuretic use demonstrated benefit in SGLT2i-treated patients, leading to the hypothesis that SGLT2i treatment might have an effect on these factors
.
Interestingly, recent analyses from DAPA-HF and DELESS showed improved health in SGLT2i-treated patients as assessed by KCCQ
.
The EMPEROR-PRESERVED trial, which evaluated both diabetic and nondiabetic patients with HFpEF, found a significant reduction in either CV death or HHF (HR 0.
79, RRR 21%, ARR 3.
3%, P<0.
001)
.
The trial confirmed the findings of SOLOIST and Score, each showing significant benefit in a subgroup of patients with HFpEF
.
EMPEROR-PRESERVED expands on these findings by demonstrating benefits for non-diabetic patients as well
.
The "2021 ESC Cardiovascular Disease Prevention Clinical Practice Guidelines" update the "2021 ESC Cardiovascular Disease Prevention Clinical Practice Guidelines" recommends that for the basic healthy population, patients with ASCVD, and patients with type 2 diabetes, risk stratification and treatment selection should be adopted.
Step-by-step" management strategy: ➤ First step: refer to recommendations that apply to all subjects; ➤ Second step: propose "10-year CV risk, lifetime CV risk, treatment benefit, comorbidities, and patient preferences" ” of intensive prevention and treatment goals (Figure 1)
.
Note: ASCVD atherosclerotic cardiovascular disease; CKD chronic kidney disease; DN diabetes; FH familial hypercholesterolemia; TOD, target organ damage Treatment Guidelines Update "2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure" recommends: For patients with HFrEF, regardless of diabetes status, SGLT2i dapagliflozin or empagliflozin (IA) is recommended in addition to optimal treatment drugs
.
Dapagliflozin or empagliflozin in combination with ACE-I/ARNI, beta-blockers, and MRAs reduced the risk of CV death and HF worsening in patients with HFrEF
.
On the premise of ensuring medication safety, these four core drugs should be used as soon as possible
.
Table 1 Drug therapy for patients with YHA grade II-IV heart failure with reduced ejection fraction (left ventricular ejection fraction ≤40%) in cardiovascular medicine 2021: diabetes and metabolic disorders, European Heart Journal, 2022;, ehab876, https://doi.
org/10.
1093/eurheartj/ehab876
