SGLT2_Inhibitor Trials at a Glance: CV, HF, Renal, and Post-MI Outcom

[어진뿌리]

🔴 Landmark #SGLT2_Inhibitor Trials at a Glance: CV, HF, Renal, and Post-MI Outcomes

🫀 CV Outcome Trials (T2D)

🔹 EMPA-REG OUTCOME (2015) – Empagliflozin
• T2D + high CV risk
• ↓ CV death 38%
• ↓ HHF 35%

🔹 CANVAS Program (2017) – Canagliflozin
• T2D + high CV risk
• ↓ MACE 14%
• ↓ HHF 33%

🔹 DECLARE-TIMI 58 (2019) – Dapagliflozin
• T2D ± ASCVD
• ↓ CV death or HHF
• Neutral MACE

🔹 VERTIS-CV (2020) – Ertugliflozin
• T2D + ASCVD
• Non-inferior for MACE
• ↓ HHF 30%

❤️ HFrEF

🔹 DAPA-HF (2019) – Dapagliflozin
• HFrEF (LVEF ≤40%)
• ↓ CV death or HHF 26%

🔹 EMPEROR-Reduced (2020) – Empagliflozin
• HFrEF (LVEF ≤40%)
• ↓ CV death or HHF 25%

❤️ HFpEF/HFmrEF

🔹 EMPEROR-Preserved (2021) – Empagliflozin
• HFpEF (LVEF >40%)
• ↓ CV death or HHF 21%

🔹 DELIVER (2022) – Dapagliflozin
• HFpEF/HFmrEF (LVEF >40%)
• ↓ CV death or HHF 18%

🚑 Acute/Worsening HF

🔹 EMPA-RESPONSE-AHF (2020)
• Improved decongestion signals

🔹 SOLOIST-WHF (2021) – Sotagliflozin
• ↓ CV death and HF events

🔹 EMPAG-HF (2022)
• Improved symptoms and diuretic response

🔹 EMPULSE (2023)
• Improved clinical outcomes

🚨 Post-MI Trials

🔹 EMMY (2022) – Empagliflozin
• ↓ NT-proBNP
• Improved LV remodeling

🔹 DAPA-MI (2024) – Dapagliflozin
• Improved cardiometabolic outcomes

🔹 EMPACT-MI (2024) – Empagliflozin
• Neutral primary endpoint
• ↓ HF hospitalization

🩺 CKD Trials

🔹 CREDENCE (2019) – Canagliflozin
• ↓ Renal outcomes 30%
• ↓ CV events 20%

🔹 DAPA-CKD (2020) – Dapagliflozin
• ↓ Renal outcomes 39%
• ↓ Mortality 31%

🔹 EMPA-KIDNEY (2023) – Empagliflozin
• ↓ Kidney disease progression 28%

🔄 Special/Overlap Trial

🔹 SCORED (2021) – Sotagliflozin
• T2D + CKD + CV risk
• ↓ HF events and CV death

✅ Key Takeaways

• Consistent reduction in HF hospitalization
• Benefits extend beyond glucose lowering
• Strong evidence in HFrEF, HFpEF, and CKD
• Benefits independent of diabetes status
• Promising post-MI data

⚠️ Limitations

• Smaller absolute benefits in low-risk populations
• Genital infections and volume depletion
• Rare euglycemic DKA
• CANVAS amputation signal
• Cost and access barriers

💊 SGLT2 Inhibitors

• Empagliflozin
• Dapagliflozin
• Canagliflozin
• Ertugliflozin
• Sotagliflozin

Bottom Line

• SGLT2 inhibitors are foundational therapies for T2D with CV/renal risk, HFrEF, HFpEF, and CKD, with emerging evidence in acute HF and post-MI care.