The Role of SGLT2-Inhibitors Across All Stages of Heart Failure and Mechanisms of Early Clinical Benefit: From Prevention to Advanced Heart Failure
Sodium-glucose cotransporter-2 inhibitors (SGLT2i), initially developed as antihyperglycemic agents, have revolutionized heart failure (HF) management, offering substantial benefits across all stages and phenotypes of the disease. Regardless of left ventricular ejection fraction (LVEF), these agents...
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2025-03-01
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| author | Simone Pasquale Crispino Andrea Segreti Vincenzo Nafisio Daniele Valente Filippo Crisci Aurora Ferro Ilaria Cavallari Annunziata Nusca Gian Paolo Ussia Francesco Grigioni |
| author_facet | Simone Pasquale Crispino Andrea Segreti Vincenzo Nafisio Daniele Valente Filippo Crisci Aurora Ferro Ilaria Cavallari Annunziata Nusca Gian Paolo Ussia Francesco Grigioni |
| author_sort | Simone Pasquale Crispino |
| collection | DOAJ |
| description | Sodium-glucose cotransporter-2 inhibitors (SGLT2i), initially developed as antihyperglycemic agents, have revolutionized heart failure (HF) management, offering substantial benefits across all stages and phenotypes of the disease. Regardless of left ventricular ejection fraction (LVEF), these agents have proven efficacy in both chronic and acute HF presentations. This review explores SGLT2i applications spanning the HF continuum, from early stages (Stage A) in at-risk individuals to the mitigation of progression in advanced HF (Stage D). Evidence from numerous trials has shown that SGLT2i significantly lower rates of HF hospitalization, improve renal function, and decreases cardiovascular mortality, highlighting their multifaced mechanisms of action in HF care. This review also highlights the potential mechanisms by which SGLT2i exert their beneficial effects on the cardiovascular and renal systems, each contributing to early and sustained clinical improvements. However, the integration of SGLT2i into guideline-directed medical therapy poses practical challenges, including initiation timing, dosing, and monitoring, which are addressed to support effective treatment adaptation across patient populations. Ultimately, this review provides a comprehensive assessment of SGLT2i as a foundational therapy in HF, emphasizing their role as an intervention across multiple stages aimed at improving outcomes across the entire HF spectrum. |
| format | Article |
| id | doaj-art-2df13a3b68e9400f9363fc785b8151bc |
| institution | DOAJ |
| issn | 2227-9059 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | MDPI AG |
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| series | Biomedicines |
| spelling | doaj-art-2df13a3b68e9400f9363fc785b8151bc2025-08-20T02:42:35ZengMDPI AGBiomedicines2227-90592025-03-0113360810.3390/biomedicines13030608The Role of SGLT2-Inhibitors Across All Stages of Heart Failure and Mechanisms of Early Clinical Benefit: From Prevention to Advanced Heart FailureSimone Pasquale Crispino0Andrea Segreti1Vincenzo Nafisio2Daniele Valente3Filippo Crisci4Aurora Ferro5Ilaria Cavallari6Annunziata Nusca7Gian Paolo Ussia8Francesco Grigioni9Department of Cardiovascular Sciences, Fondazione Policlinico Campus Bio-Medico di Roma, 00128 Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Campus Bio-Medico di Roma, 00128 Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Campus Bio-Medico di Roma, 00128 Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Campus Bio-Medico di Roma, 00128 Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Campus Bio-Medico di Roma, 00128 Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Campus Bio-Medico di Roma, 00128 Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Campus Bio-Medico di Roma, 00128 Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Campus Bio-Medico di Roma, 00128 Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Campus Bio-Medico di Roma, 00128 Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Campus Bio-Medico di Roma, 00128 Rome, ItalySodium-glucose cotransporter-2 inhibitors (SGLT2i), initially developed as antihyperglycemic agents, have revolutionized heart failure (HF) management, offering substantial benefits across all stages and phenotypes of the disease. Regardless of left ventricular ejection fraction (LVEF), these agents have proven efficacy in both chronic and acute HF presentations. This review explores SGLT2i applications spanning the HF continuum, from early stages (Stage A) in at-risk individuals to the mitigation of progression in advanced HF (Stage D). Evidence from numerous trials has shown that SGLT2i significantly lower rates of HF hospitalization, improve renal function, and decreases cardiovascular mortality, highlighting their multifaced mechanisms of action in HF care. This review also highlights the potential mechanisms by which SGLT2i exert their beneficial effects on the cardiovascular and renal systems, each contributing to early and sustained clinical improvements. However, the integration of SGLT2i into guideline-directed medical therapy poses practical challenges, including initiation timing, dosing, and monitoring, which are addressed to support effective treatment adaptation across patient populations. Ultimately, this review provides a comprehensive assessment of SGLT2i as a foundational therapy in HF, emphasizing their role as an intervention across multiple stages aimed at improving outcomes across the entire HF spectrum.https://www.mdpi.com/2227-9059/13/3/608acute heart failure (AHF)chronic heart failure (CHF)four pillarsfoundational therapyGDMTheart failure (HF) |
| spellingShingle | Simone Pasquale Crispino Andrea Segreti Vincenzo Nafisio Daniele Valente Filippo Crisci Aurora Ferro Ilaria Cavallari Annunziata Nusca Gian Paolo Ussia Francesco Grigioni The Role of SGLT2-Inhibitors Across All Stages of Heart Failure and Mechanisms of Early Clinical Benefit: From Prevention to Advanced Heart Failure Biomedicines acute heart failure (AHF) chronic heart failure (CHF) four pillars foundational therapy GDMT heart failure (HF) |
| title | The Role of SGLT2-Inhibitors Across All Stages of Heart Failure and Mechanisms of Early Clinical Benefit: From Prevention to Advanced Heart Failure |
| title_full | The Role of SGLT2-Inhibitors Across All Stages of Heart Failure and Mechanisms of Early Clinical Benefit: From Prevention to Advanced Heart Failure |
| title_fullStr | The Role of SGLT2-Inhibitors Across All Stages of Heart Failure and Mechanisms of Early Clinical Benefit: From Prevention to Advanced Heart Failure |
| title_full_unstemmed | The Role of SGLT2-Inhibitors Across All Stages of Heart Failure and Mechanisms of Early Clinical Benefit: From Prevention to Advanced Heart Failure |
| title_short | The Role of SGLT2-Inhibitors Across All Stages of Heart Failure and Mechanisms of Early Clinical Benefit: From Prevention to Advanced Heart Failure |
| title_sort | role of sglt2 inhibitors across all stages of heart failure and mechanisms of early clinical benefit from prevention to advanced heart failure |
| topic | acute heart failure (AHF) chronic heart failure (CHF) four pillars foundational therapy GDMT heart failure (HF) |
| url | https://www.mdpi.com/2227-9059/13/3/608 |
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