EC Cardiology

The incidence of heart failure with preserved ejection fraction (HFpEF), for which there is no established treatment, may increase with age. Recently, the sodium-glucose cotransporter-2 inhibitor (SGLT2i) has emerged as a promising drug not only for heart failure with reduced ejection fraction but also for HFpEF at any age independent of diabetes mellitus. Empagliflozin (empa) and dapagliflozin (dapa) have shown long-term cardiovascular benefits in large randomized controlled trials by comparing with controls. Empa and dapa have high SGLT2 selectivity of 5,000 and 1242 fold, respectively. The metabolic rate of empa is lower than that of the other SGLT2i, resulting in unchanged body mass in urine, which inhibits the SGLT2 receptor in the proximal convoluted tubule. Based on these mechanisms, empa and dapa may provide an additional effect to existing standard heart failure drugs through pleiotropic effects other than diuretic action. As it is often challenging to treat HFpEF in elderly patients due to worsening renal function by using loop diuretics, timely application of SGLT2i would reduce the dose of diuretics and provide benefit if side effects such as dehydration (especially when using diuretics), ketoacidosis, urinary tract/genital infections could be avoided.

Keywords: Heart Failure with Preserved Ejection Fraction (HFpEF); Sodium-Glucose Cotransporter-2 Inhibitors; Older Adults; Elderly; Benefit; Risk; Diuretics

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