Empagliflozin reduced the combined risk of cardiovascular death or first heart failure hospitalization (HR 0.79) compared to placebo in patients with heart failure and preserved ejection fraction.
Do neurohormonal antagonists and SGLT2 inhibitors reduce cardiovascular death or heart failure hospitalization in patients with HFpEF?
This review highlights the paradigm shift in HFpEF management from the historical failure of neurohormonal antagonists to the proven clinical efficacy of SGLT2 inhibitors like empagliflozin.
Estimación del efecto: HR 0.79 (95% CI 0.69-0.90)
Tasa de eventos absoluta: 13.8% vs 17.1%
valor p: p=<0.001
Heart failure with preserved ejection fraction (HFpEF) is a highly prevalent syndrome with multifaceted pathophysiology. All approaches to neurohormonal modulation were shown not to improve survival in HFpEF, despite their well-established efficacy in heart failure with reduced ejection fraction (HFrEF). This might be attributed to suboptimal study design, inadequate diagnostic criteria, or statistical power, but is also likely to reflect a lack of consideration for its clinical heterogeneity. The attention then shifted to the phenotypic heterogeneity of HFpEF, with the ultimate goal of developing therapies tailored to individual patient phenotypes. Recently, the sodium-glucose co-transporter-2 inhibitor (SGLT2i) empagliflozin has been found to reduce the combined risk of cardiovascular death or hospitalization for HF in patients with HFpEF, a result driven by a reduction in HF hospitalizations. This paper recapitulates the journey from the failure of trials on neurohormonal antagonists to the attempts of personalized approaches and the new perspectives of SGLT2i therapy for HFpEF.
Aimo et al. (Fri,) conducted a review in Heart failure with preserved ejection fraction (HFpEF) (n=5,988). Empagliflozin vs. Placebo was evaluated on Cardiovascular death or first HF hospitalization (HR 0.79, 95% CI 0.69-0.90, p=<0.001). Empagliflozin reduced the combined risk of cardiovascular death or first heart failure hospitalization (HR 0.79) compared to placebo in patients with heart failure and preserved ejection fraction.