Every year around 460,000 people are admitted to hospital for chronic heart failure just in Germany. More than any other disease. The causes of chronic heart failure include conditions such as high blood pressure, other types of coronary heart disease, heart attacks, or myocarditis. On top of that, some forms of myocardial disease also have a genetic predisposition.
The repercussions of this disease are a significant decline in the quality of life and a higher, premature mortality rate. Treatment of the disease still poses problems. Although there are currently effective drugs available to treat heart failure and especially its underlying conditions, the number of hospitalizations and mortality rates are still very high. However, new research data now offers cause for hope. Two drugs from the group of SGLT 2 inhibitors originally developed for diabetes mellitus have proven to be very effective against heart failure: Dapagliflozin and empagliflozin.
Reduced risk of cardiovascular death
SGLT2 inhibitors block glucose reabsorption back into the blood from the so-called primary urine. This leads to a loss of glucose and thus to a lowering of blood sugar levels. Apart from the loss of glucose via the kidneys, these drugs also cause the body to lose sodium. This consequently leads to metabolic changes that could have a beneficial effect on the heart.
In two large studies conducted in Germany under the direction of the German Cardiology Society (DGK) / Heart and Circulation Research, the effect of the two drugs on cardiac failure has now been examined. These are large multi-center studies with a total of more than 8,000 patients who received double-blind and randomized treatment. Patients with heart failure, with or without diabetes, and with limited ventricular function were included. All of whom continued to receive the optimal standard of care for heart failure.
Both studies revealed that the risk of cardiovascular death and heart failure hospital admissions decreased by approximately 25%. The scientists reported that the effects were comparable in both studies regardless of modern complementary treatments. And in patients with and without diabetes mellitus.
Diabetes medication becomes heart failure medication
“What is impressive is the consistent decline in heart failure complications in diabetics and non-diabetics in these studies,” says Prof. Dr. Michael Böhm, press spokesperson of the DGK and scientific director of both studies for Germany. “This shows that it is possible to turn a diabetes medication into an effective heart failure medication with proven efficacy in non-diabetics.” These study outcomes are “really good news for all patients with heart failure. To date, no other drug has shown such convincing results, even more so because it also significantly improves kidney function,” emphasizes Prof. Andreas Zeiher, president of the German Society of Cardiology.
Böhm now expects that the SGLT2 inhibitors will most likely be included in the European Guidelines for the Diagnosis and Therapy of Heart Failure, which is due to be published in 2021. This new heart failure guideline is currently being prepared by an international panel of experts.
The results of both studies were published in the New England Journal of Medicine.
https://www.nejm.org/doi/10.1056/NEJMc1917241
https://www.nejm.org/doi/full/10.1056/NEJMoa2022190
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