Sodium-Glucose Cotransporter 2 Inhibition in Heart Failure with Preserved Ejection Fraction: From Mechanism to Ward Round
DOI:
https://doi.org/10.5281/zenodo.22305468Keywords:
Heart failure with preserved ejection fraction, SGLT2 inhibitors, Empagliflozin, Dapagliflozin, Ejection fractionAbstract
Sodium-glucose cotransporter 2 (SGLT2) inhibitors entered cardiology as a secondary observation in trials designed to test
glucose lowering, and have since become the first drug class to show a consistent benefit in heart failure with preserved
ejection fraction (HFpEF), a population for which decades of neurohormonal-antagonist trials had produced little. This
review assembles the trial programme from the original type 2 diabetes cardiovascular outcome trials through
EMPEROR-Preserved and DELIVER to the pooled five-trial meta-analysis, and sets out what a clinician should actually
expect at the ward round. Across the full ejection-fraction spectrum, SGLT2 inhibitors reduce the composite of cardiovascular
death and heart failure hospitalization (pooled hazard ratio 0.77, 95% confidence interval 0.72-0.90); however, that benefit is
overwhelmingly a hospitalization story rather than a mortality story, and it measurably narrows toward the highest ejection
fractions, precisely the range in which true HFpEF is hardest to distinguish from its mimics. The mechanism remains
unsettled. We argue that this qualification, not the headline hazard ratio, is what should be communicated to patients
Heart failure with preserved ejection fraction; SGLT2 inhibitors; Empagliflozin; Dapagliflozin; Ejection
fraction
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