Challenges of Sodium-glucose Transporter-2 Inhibitors Use in a low Socioeconomic Setting
Main Article Content
Abstract
Background: Sodium-glucose transporter-2 (SGLT2) inhibitors have shown efficacy in reducing major adverse cardiovascular events and hospitalizations for heart failure in patients with type 2 diabetes mellitus and concomitant heart failure.
Aim: To compare the short-term effectiveness between empagliflozin and dapagliflozin.
Methods: A single-center observational cohort study was implemented in a Dominican tertiary-care center, where patients with heart failure and reduced ejection fraction were divided into two groups and treated with different SGLT2 inhibitor molecules, empagliflozin and dapagliflozin. Two-step cluster analysis was conducted for the interim analysis of the study.
Results: We enrolled a total of 60 patients, with a median age of 69. The majority of these were men (70%) and comprised 75.0% of the Dapagliflozin 10 mg group and 62.5% of the Empagliflozin 10 mg group. Most participants (61.7%) were categorized as NYHA-II in functional class. The main cause of heart failure was ischemic (55%), while the predominant state of the disease was chronic with 65% patients in this group.
Conclusion: This preliminary manuscript evaluated the effectiveness of SGLT2 inhibitors in a Dominican heart failure patient cohort, finding notable gender, age, and risk factor variations, and emphasizing the need for standardized research methods in future investigations.
Keywords:
heart failure, sodium-glucose transporter-2 inhibitors, heart diseases, cluster analysis
Article Details
How to Cite
CRUZ, Licurgo J et al.
Challenges of Sodium-glucose Transporter-2 Inhibitors Use in a low Socioeconomic Setting.
Medical Research Archives, [S.l.], v. 11, n. 12, dec. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4830>. Date accessed: 15 may 2024.
doi: https://doi.org/10.18103/mra.v11i12.4830.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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8. Lenahan CM, Harrington D, Stueben F. SGLT2 inhibitors: what role do they play in heart failure with reduced ejection fraction? Nurse Pract. July 1st, 2021;46(7):30-7. doi: http://dx.doi.org/10.1097/01.NPR.0000753832.85114.65
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10. Cediel G, Codina P, Spitaleri G, et al. Gender-related differences in heart failure biomarkers. Front Cardiovasc Med. January 5th, 2021;7:617705. doi: http://dx.doi.org/10.3389/fcvm.2020.617705
11. Speranza MO, Díaz JP, Zavaleta E, et al. Effect of sodium-glucose cotransporter 2 inhibitors on clinical and laboratory variables in heart failure patients with reduced left ventricular ejection fraction in a Latin American hospital: a retrospective study. Hearts. February 25th, 2023;4(1):20-7. doi: https://doi.org/10.3390/hearts4010003
12. Warner V, Nguyen D, Bayles T, et al. Management of heart failure in older people. J Pharm Pract Res. February 1st, 2022;52(1):72-9. doi: https://doi.org/10.1002/jppr.1796
13. Lawson CA, Zaccardi F, Squire I, et al. Risk factors for heart failure. Circ Heart Fail. February, 2020;13(2). doi: https://doi.org/10.1161/CIRCHEARTFAILURE.119.006472
14. Son YJ, Lee HJ. Association between persistent smoking after a diagnosis of heart failure and adverse health outcomes: a systematic review and meta-analysis. Tob Induc Dis. January 20th, 2020;18(05). doi: 10.18332/tid/116411
15. Ding N, Shah AM, Blaha MJ, et al. Cigarette smoking, cessation, and risk of heart failure with preserved and reduced ejection fraction. J Am Coll Cardiol. June 14th, 2022;79(23). doi: 10.1016/j.jacc.2022.03.377.
16. Bragazzi NL, Zhong W, Shu J, et al. Burden of heart failure and underlying causes in 195 countries and territories from 1990 to 2017. Eur J Prev Cardiol. February 12th, 2021;28(15):1682–90. doi:10.1093/eurjpc/zwaa147
17. Straubhaar B, Krähenbühl S, Schlienger RG. The prevalence of potential drug-drug interactions in patients with heart failure at hospital discharge. Drug Saf. November 20th, 2012;29(1):79–90. doi: https://doi.org/10.2165/00002018-200629010-00006
18. van Veldhuisen DJ, Charlesworth A, Crijns HJ, et al. Differences in drug treatment of chronic heart failure between European countries. Eur Heart J. May 1st, 1999;20(9):666-72. Available from: https://academic.oup.com/eurheartj/article-pdf/20/9/666/17882804/666.pdf
19. Butler J, Anker SD, Filippatos G, et al. Empagliflozin and health-related quality of life outcomes in patients with heart failure with reduced ejection fraction: the EMPEROR-reduced trial. Eur Heart J. January 9th, 2021;42(13):1203-12. doi:10.1093/eurheartj/ehaa1007
20. Lee HC, Shiou YL, Jhuo SJ, et al. The sodium–glucose co-transporter 2 inhibitor empagliflozin attenuates cardiac fibrosis and improves ventricular hemodynamics in hypertensive heart failure rats. Cardiovasc Diabetol. April 1st, 2019;18(1):1-13. doi: https://doi.org/10.1186/s12933-019-0849-6
21. Correlation of B-type natriuretic peptide level to 6-min walk test performance in patients with left ventricular systolic dysfunction. Clin Chim Acta. February 1st, 2003;328(1-2):87–90. doi: http://dx.doi.org/10.1016/S0009-8981(02)00389-3
22. Gegenhuber A, Struck J, Dieplinger B, et al. Comparative evaluation of B-type natriuretic peptide, mid-regional pro-A-type natriuretic peptide, mid-regional pro-adrenomedullin, and copeptin to predict 1-year mortality in patients with acute destabilized heart failure. J Card Fail. February, 2007;13(1). doi: 10.1016/j.cardfail.2006.09.004.
23. Zhao X, Wang D, Qin L. Lipid profile and prognosis in patients with coronary heart disease: a meta-analysis of prospective cohort studies. BMC Cardiovasc Disord. February 3rd, 2021;21(1):1–15. doi: https://doi.org/10.1186/s12872-020-01835-0
24. Caleyachetty R, Thomas GN, Toulis KA, et al. Metabolically healthy obese and incident cardiovascular disease events among 3.5 million men and women. J Am Coll Cardiol. September 19th, 2017;70(12):1429-37. doi: http://dx.doi.org/10.1016/j.jacc.2017.07.763
25. Pelkman CL, Fishell VK, Maddox DH, et al. Effects of moderate-fat (from monounsaturated fat) and low-fat weight-loss diets on the serum lipid profile in overweight and obese men and women. Am J Clin Nutr. February 1st, 2004;79(2):204–12. doi: http://dx.doi.org/10.1093/ajcn/79.2.204
26. Gacita AM, Dellefave L, Page PG, et al. Altered enhancer and promoter usage leads to differential gene expression in the normal and failed human heart. Circ Heart Fail. October, 2020;13(10). doi: https://doi.org/10.1161/CIRCHEARTFAILURE.120.006926
27. Lennie TA, Andreae C, Rayens MK, et al. Micronutrient deficiency independently predicts time to event in patients with heart failure. J Am Heart Assoc. September 4th, 2018;7(17). doi: https://doi.org/10.1161/JAHA.117.007251
28. Echouffo JB, Butler J, Yancy CW, et al. Association of physical activity or fitness with incident heart failure. Circ Heart Fail. July 14th, 2015;8(5). doi: https://doi.org/10.1161/circheartfailure.115.002070
2. Savarese G, Lund LH. Global public health burden of heart failure. Card Fail Rev. April, 2017;3(1):7-11. doi: 10.15420/cfr.2016:25:2.
3. Hunt et al. Stages in the development of HF and recommended therapy by stage [cited 2023 Oct 4]. Available from: https://www.heart.org/-/media/Files/Health-Topics/Heart-Failure/RAHF-Guidelines-toolkit-algorithm.pdf
4. Verma S, McMurray JJ. The serendipitous story of SGLT2 inhibitors in heart failure. Circulation. May 28th, 2019;139(22):2537–41. doi: http://dx.doi.org/10.1161/CIRCULATIONAHA.119.040514
5. Rosano GM, Vitale C, Seferovic P. Heart failure in patients with diabetes mellitus. Card Fail Rev. April, 2017;3(1):52–5. doi: http://dx.doi.org/10.15420/cfr.2016:20:2
6. Zhai M, Du X, Liu C, et al. The effects of dapagliflozin in patients with heart failure complicated with type 2 diabetes: a meta-analysis of placebo-controlled randomized trials. Front Clin Diabetes Healthc. June 30th, 2021;2. doi: https://doi.org/10.3389/fcdhc.2021.703937
7. Tsampasian V, Baral R, Chattopadhyay R, et al. The role of SGLT2 inhibitors in heart failure: a systematic review and meta-analysis. Cardiol Res Pract. August 19th, 2021;2021:9927533. doi: http://dx.doi.org/10.1155/2021/9927533
8. Lenahan CM, Harrington D, Stueben F. SGLT2 inhibitors: what role do they play in heart failure with reduced ejection fraction? Nurse Pract. July 1st, 2021;46(7):30-7. doi: http://dx.doi.org/10.1097/01.NPR.0000753832.85114.65
9. Lam CS, Arnott C, Beale AL, et al. Sex differences in heart failure. Eur Heart J [Internet]. December 4th, 2019;40(47):3859-68c. doi: 10.1093/eurheartj/ehz835
10. Cediel G, Codina P, Spitaleri G, et al. Gender-related differences in heart failure biomarkers. Front Cardiovasc Med. January 5th, 2021;7:617705. doi: http://dx.doi.org/10.3389/fcvm.2020.617705
11. Speranza MO, Díaz JP, Zavaleta E, et al. Effect of sodium-glucose cotransporter 2 inhibitors on clinical and laboratory variables in heart failure patients with reduced left ventricular ejection fraction in a Latin American hospital: a retrospective study. Hearts. February 25th, 2023;4(1):20-7. doi: https://doi.org/10.3390/hearts4010003
12. Warner V, Nguyen D, Bayles T, et al. Management of heart failure in older people. J Pharm Pract Res. February 1st, 2022;52(1):72-9. doi: https://doi.org/10.1002/jppr.1796
13. Lawson CA, Zaccardi F, Squire I, et al. Risk factors for heart failure. Circ Heart Fail. February, 2020;13(2). doi: https://doi.org/10.1161/CIRCHEARTFAILURE.119.006472
14. Son YJ, Lee HJ. Association between persistent smoking after a diagnosis of heart failure and adverse health outcomes: a systematic review and meta-analysis. Tob Induc Dis. January 20th, 2020;18(05). doi: 10.18332/tid/116411
15. Ding N, Shah AM, Blaha MJ, et al. Cigarette smoking, cessation, and risk of heart failure with preserved and reduced ejection fraction. J Am Coll Cardiol. June 14th, 2022;79(23). doi: 10.1016/j.jacc.2022.03.377.
16. Bragazzi NL, Zhong W, Shu J, et al. Burden of heart failure and underlying causes in 195 countries and territories from 1990 to 2017. Eur J Prev Cardiol. February 12th, 2021;28(15):1682–90. doi:10.1093/eurjpc/zwaa147
17. Straubhaar B, Krähenbühl S, Schlienger RG. The prevalence of potential drug-drug interactions in patients with heart failure at hospital discharge. Drug Saf. November 20th, 2012;29(1):79–90. doi: https://doi.org/10.2165/00002018-200629010-00006
18. van Veldhuisen DJ, Charlesworth A, Crijns HJ, et al. Differences in drug treatment of chronic heart failure between European countries. Eur Heart J. May 1st, 1999;20(9):666-72. Available from: https://academic.oup.com/eurheartj/article-pdf/20/9/666/17882804/666.pdf
19. Butler J, Anker SD, Filippatos G, et al. Empagliflozin and health-related quality of life outcomes in patients with heart failure with reduced ejection fraction: the EMPEROR-reduced trial. Eur Heart J. January 9th, 2021;42(13):1203-12. doi:10.1093/eurheartj/ehaa1007
20. Lee HC, Shiou YL, Jhuo SJ, et al. The sodium–glucose co-transporter 2 inhibitor empagliflozin attenuates cardiac fibrosis and improves ventricular hemodynamics in hypertensive heart failure rats. Cardiovasc Diabetol. April 1st, 2019;18(1):1-13. doi: https://doi.org/10.1186/s12933-019-0849-6
21. Correlation of B-type natriuretic peptide level to 6-min walk test performance in patients with left ventricular systolic dysfunction. Clin Chim Acta. February 1st, 2003;328(1-2):87–90. doi: http://dx.doi.org/10.1016/S0009-8981(02)00389-3
22. Gegenhuber A, Struck J, Dieplinger B, et al. Comparative evaluation of B-type natriuretic peptide, mid-regional pro-A-type natriuretic peptide, mid-regional pro-adrenomedullin, and copeptin to predict 1-year mortality in patients with acute destabilized heart failure. J Card Fail. February, 2007;13(1). doi: 10.1016/j.cardfail.2006.09.004.
23. Zhao X, Wang D, Qin L. Lipid profile and prognosis in patients with coronary heart disease: a meta-analysis of prospective cohort studies. BMC Cardiovasc Disord. February 3rd, 2021;21(1):1–15. doi: https://doi.org/10.1186/s12872-020-01835-0
24. Caleyachetty R, Thomas GN, Toulis KA, et al. Metabolically healthy obese and incident cardiovascular disease events among 3.5 million men and women. J Am Coll Cardiol. September 19th, 2017;70(12):1429-37. doi: http://dx.doi.org/10.1016/j.jacc.2017.07.763
25. Pelkman CL, Fishell VK, Maddox DH, et al. Effects of moderate-fat (from monounsaturated fat) and low-fat weight-loss diets on the serum lipid profile in overweight and obese men and women. Am J Clin Nutr. February 1st, 2004;79(2):204–12. doi: http://dx.doi.org/10.1093/ajcn/79.2.204
26. Gacita AM, Dellefave L, Page PG, et al. Altered enhancer and promoter usage leads to differential gene expression in the normal and failed human heart. Circ Heart Fail. October, 2020;13(10). doi: https://doi.org/10.1161/CIRCHEARTFAILURE.120.006926
27. Lennie TA, Andreae C, Rayens MK, et al. Micronutrient deficiency independently predicts time to event in patients with heart failure. J Am Heart Assoc. September 4th, 2018;7(17). doi: https://doi.org/10.1161/JAHA.117.007251
28. Echouffo JB, Butler J, Yancy CW, et al. Association of physical activity or fitness with incident heart failure. Circ Heart Fail. July 14th, 2015;8(5). doi: https://doi.org/10.1161/circheartfailure.115.002070