Changing the «rules of the game» in the treatment of patients with heart failure: a focus on empagliflozin

Abstract

SGLT2 inhibitors are drugs that «changed the rules of the game» in endocrinology, cardiology and nephrology. Empagliflozin has notable cardio-renal organoprotective properties regardless of the presence of type 2 diabetes and it is probably the most versatile molecule among SGLT2 inhibitors. The mechanisms of simultaneous empagliflozin blockade of SGLT2-channels and NHE3-channels were considered in scientific review as the cause of the natriuretic effect of the drug. NHE channels blockade in myocardial cells causes a decrease in the load of cells with sodium and calcium. Attention is focused on the ability of empagliflozin to lower blood pressure, selectively reduce the volume of interstitial fluid, affect the geometry of the LV, inhibiting its remodeling. The first large EMPA-REG OUTCOME trial in patients with atherosclerotic cardiovascular disease was reviewed, which found a clinically meaningful effect of empagliflozin on 3P-MACE, reduced risk of cardiovascular death, all-cause death, and heart failure hospitalization. It was analyzed the results of studies of empagliflozin in patients with chronic heart failure (CHF) with different LVEF and in patients with acute heart failure (AHF) (EMPEROR-REDUCED, EMPEROR-PRESERVED and EMPULSE). Attention is focused on the fact that empagliflozin currently has a sufficient evidence base to be a mandatory drug for the whole spectrum of patients with CHF and AHF with an early start of therapy even before discharge from the hospital.