Effects of Sodium-Glucose Cotransporter 2 Inhibitor on Vascular Endothelial and Diastolic Function in Heart Failure With Preserved Ejection Fraction ― Novel Prospective Cohort Study ―

Abstract

with demonstrated beneficial cardiovascular effects. Based on the ENPA-REG OUTCOME results, some clinical practice guidelines now recommend these drugs for patients with type 2 diabetes mellitus (DM) who have not achieved glycemic targets and who have notable atherosclerotic disease. As evidence on SGLT2 inhibitors continues to evolve,8,9 integrated analysis of CANVAS and CANVAS-R (the CANVAS program) has been undertaken to maximize statistical power to detect plausible effects of canagliflozin on cardiovascular, kidney, and safety outcomes.10,11 Sodiumrelated physiological effects of SGLT2 inhibitors and clinical correlates of natriuresis, such as the impact on blood pressure (BP), HF, kidney protection, and mortality, will be a major management focus. SGLT2 inhibitors exert a variety of additional metabolic effects, including improvement in insulin sensitivity, reduced glucose toxicity, and H eart failure with preserved ejection fraction (HFpEF) accounts for almost half of all heart failure (HF) cases.1−3 The morbidities and mortality of HFpEF are similar to those in HF patients with reduced ejection fraction (HFrEF),1,2,4−7 but, in contrast to HFrEF, there is no proven treatment for HFpEF, despite the increasing prevalence and hospitalization rate. This disorder has a complex pathophysiology and has been increasingly characterized as a heterogeneous syndrome that is caused or exacerbated by a variety of factors linked to both cardiac and extracardiac abnormalities. Endothelial dysfunction and abnormal vascular structure may be involved in the pathogenesis. No treatment has been identified to improve prognosis. The sodium-glucose cotransporter 2 (SGLT2) inhibitors are now widely approved as an anti-hyperglycemic treatment. They constitute a new class of anti-diabetic agent