Heart failure with preserved ejection fraction therapy: combining sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists

“Will we see progressive providers prescribing 'ahead' of guidelines? Maybe. A recent JACC editorial suggests that SGLT2is and GLP-1 RAs should be considered standard of care for high-risk individuals, given the clear benefits of each drug via distinct pathways. That said, the majority of patients who could benefit from either (or both) of these therapies are not getting them – highlighting the need for additional data and tools that could influence practice patterns.”

“GLP-1 receptor agonists [have] been found to improve the quality of life of patients with obesity and type 2 diabetes combined with HFpEF. However, its additive benefits for patients with HFpEF who are already on SGLT2 inhibitor treatment have not been assessed. In addition, despite synergistic metabolic effects noted in prior studies, including improved glycemic control and weight loss with the combination of GLP-1 receptor agonist and SGLT2 inhibitor use, there has been a theoretical concern that the combination of these agents can negate the effects of SGLT2 inhibitors on cardiac and renal workload and decrease the cardiorenal benefits because of the differential effect on ketone bodies.”

“When these trials were first conducted, the main point was to make sure these diabetes medications were not harmful to the heart because of earlier trials that had shown neutral or even harmful effects. When EMPEROR came out and we showed that there was no harmful effect, but actually a benefit, I think it was a really big turning point and a really big part of that shift because we realized these are not just diabetes medications and they can actually be really big players in the space of heart failure, which they have been.”