Hello my name is jennifer andreian sandoya the topic is the polyphilosome patients with a heart failure and reduces the ejection fraction definition in patients with type 2 diabetes inhibitors of the young glucose co-transporter 2 es glt2 reduce the rise of a first hospitalization for heart failure possibly throughout glucose independent mechanics more that are
Needed regarding the effects of sglt2 inhibitors in patients with established her failure and a reduced ejection fraction rare less of their presence or absence of dietary habits applications amazing large clinical trials involving patients with a type 2 diabetes have shown that inivitator of sodium glucose got transported to reduce the rise of hospitalization for
Heart failure most patients in these drills did not have her failure at puzzling so the benefit of treatment with an seo t2 in uterus largely reflected prevention of incident hair failure studies have shown that in patients with type 2 diabetes inhibition of the sodium glucose co-transporter 2 or sglt2 reduces the risk of hospitalization due to heart failure the
Mechanism by which this occurs is not yet understood it’s been hypothesized that sglt2 inhibition may prevent heart failure complications even in the absence of diabetes in this multi-center randomized placebo-controlled trial 4744 patients with new york heart association class 2 to 4 heart failure and an ejection fraction of 40 percent or less were randomized
To receive either dapagliflozin or placebo in addition to standard heart failure therapy randomization was stratified by the co-diagnosis of type 2 diabetes the primary outcome was a composite of a first episode of worsening heart failure or cardiovascular death over an 18.2 month median follow-up the primary outcome occurred in 16.3 percent of the patients
Receiving dapagliflozin as compared with 21.2 percent of those receiving placebo the findings were similar in patients with or without diabetes the rates of adverse events were not significantly different between the two study groups with volume depletion and renal dysfunction being the most common the authors concluded that in patients with heart failure and
Reduced ejection fraction dapagliflozin reduced the risk of worsening heart failure or cardiovascular death even in patients without diabetes full trial results are available at nejm.org studies have shown that in patients with type 2 diabetes inhibition of the sodium glucose co-transporter 2 or sglt2 reduces the risk of hospitalization due to heart failure the
Mechanism by which this occurs is not yet understood it’s been hypothesized that sglt2 inhibition may prevent a decent randomized placebo-controlled trial 4744 patients with near-heart failure and an ejection fraction of 40 percent or less epiglyphosis or placebo in addition to standard heart failure randomization was stratified gnosis that primary outcome was
An episode of worsening heart failure or cardiovascular point two month in follow-up the primary outcome occurs as receiving dabogliflozin as compared with 21.2 diabetes the rates of adverse events were not significantly different common the authors concluded that impatience would definitely reduce the risk of worsening.org present comes press the principal layer
As ult to inhibitors improve ventricular valine in conditions lcl t2 inhibitors improve cardiac metabolisms and your energies cons the main cause hyposemia renal balloon depletion diabetes ketosis is what are was more common with adapter adaptability fossil so so the benefits of topical fluzen were identical in patients with and without diabetes and even
More so among the patients without diabetes the benefits of topical flows and were consistent right across the spectrum of glycated hemoglobin so even patients with a completely normal hemoglobin a1c got as much benefit as other patients and clearly that questions the idea that in heart failure this is just about lowering glucose and in fact the patients without
Diabetes randomized adaptoglucan had no reduction in hemoglobin a1c either again questioning the benefits and heart failure just being about reducing glucose so the alternative possibilities are that these agents do have at least in the short term a diuretic effect that might be beneficial but it’s unlikely to be the whole explanation these drugs do protect the
Kidneys to slow the progressive deterioration and renal function that we see in patients with heart failure and we’ve reported that with dapicoflozin both in patients with and without diabetes and then i think the third idea at least is that these drugs might have beneficial effects in the heart now these are largely still in human beings hypotheses but probably
The two major ones are firstly that these drugs might improve myocardial energetics make the heart more metabolically efficient and in that way work better one reason why that might be is because they increase the production of ketones and you can think of ketones in a very simplistic way as a super fuel for the heart that are more metabolically efficient and
Then the other explanation but again very hypothetical and experimental is that sglt2 inhibitors might interact with what’s called the sodium hydrogen exchanger on heart muscle cells cardiomyocytes and by reducing intracellular sodium might for example reduce the risk of sudden death but we don’t have any firm human evidence for that it’s a speculative mechanism
Dapagliflozin has two key roles when it comes to thinking about heart failure the first is with very strong evidence that dapagliflozin and the whole sglt2 inhibitor family reduce the risk of incident heart failure so if you’ve got type 2 diabetes one of the major risks you face is developing heart failure and application like other sglt2 inhibitors unequivocally
Reduces that risk substantially what’s new is that we now know that diaper glucosing is also a treatment for established heart failure so moving from prevention to treatment we can use treat patients with heart failure both with and without type 2 diabetes is applying aquarius the polyphlosine reduce the combinator risk of death from cardiovascular causes and
Hospitalization for heart failure in patients with diet studio it is malaria with and without kidneys so we designed the dap hf trial to test the hypothesis that the glucose luring sglt2 inhibitor dapagliflozin might be of benefit in patients with heart failure and reduced ejection fraction when added to conventional therapy we designed to trial to see whether
That was the case in patients with diabetes and in patients with diabetes the latter constituted 55 percent of all of our patients and we find that the apical flows and reduced morbidity and mortality and improve symptoms overall and individually in patients with diabetes and also in health ref patients who did not have diabetes in addition to that dapagal
Flozen was very well tolerated compared to placebo and in patients without diabetes we saw no evidence of hypoglycemia we saw no cases of diabetic ketoacidosis conclusion as ull t2 inhibitor have emerged as powerful pharmacological tools in the prevention of her failure with the suggestion that online with other glucose lowering against this benefit maybe uh
Was served across the expression of people with dietary averages with a widow established a cardiovascular disease stance
Transcribed from video
Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction By Andrea Guillén
