Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have consistently demonstrated a reduction in hospitalization for HF, independent of baseline T2DM control or presence of HF at enrollment, in multiple large-scale randomized controlled trials, such as the EMPA-REG OUTCOME (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients), CANVAS (Canagliflozin Cardiovascular Assessment Study), DECLARE-TIMI 58 (Dapagliflozin Effect on Cardiovascular Events–Thrombolysis in Myocardial Infarction 58), and DAPA-HF (Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction) trials.

For this 67-year-old man with T2DM, established atherosclerotic cardiovascular disease, and mildly decreased kidney function (eGFR 51 mL/min/1.73 m²), addition of an SGLT2i such as empagliflozin would be appropriate. SGLT2is provide both cardioprotective and kidney-protective benefits, including the prevention of new or worsening HF and the slowing of kidney disease progression.

Metformin has not been shown to specifically reduce HF hospitalizations. Glyburide, a sulfonylurea, improves glucose levels but increases hypoglycemia risk and has no HF benefit. Saxagliptin, a dipeptidyl peptidase-4 inhibitor, was associated with an increased risk of HF hospitalization in the SAVOR-TIMI 53 (Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus–Thrombolysis in Myocardial Infarction 53) trial.

This patient case quiz is part of the larger Managing HF Across the Spectrum: From Recognizing Symptoms to Implementing Appropriate Treatment initiative, supported by Bayer. To visit the Managing HF Across the Spectrum page and access additional educational activities on this topic, click here.

References

1. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(17):e263-e421. doi:10.1016/j.jacc.2021.12.012
2. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117-2128. doi:10.1056/NEJMoa1504720
3. Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377(7):644-657. doi:10.1056/NEJMoa1611925
4. Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019;380(4):347-357. doi:10.1056/NEJMoa1812389