Sodium Glucose Cotransporter-2 Inhibition and Cardiorenal Protection: JACC Review Topic of the Week

David Z Cherney; Ayodele Odutayo; Ronnie Aronson; Justin Ezekowitz; John D Parker

doi:10.1016/j.jacc.2019.09.022

Sodium Glucose Cotransporter-2 Inhibition and Cardiorenal Protection: JACC Review Topic of the Week

J Am Coll Cardiol. 2019 Nov 19;74(20):2511-2524. doi: 10.1016/j.jacc.2019.09.022.

Authors

David Z Cherney¹, Ayodele Odutayo², Ronnie Aronson³, Justin Ezekowitz⁴, John D Parker⁵

Affiliations

¹ Toronto General Hospital Research Institute, UHN, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada; Banting and Best Diabetes Centre, Toronto, Ontario, Canada. Electronic address: david.cherney@uhn.ca.
² Department of Medicine, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada; Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
³ LMC Diabetes and Endocrinology, Toronto, Ontario, Canada.
⁴ Department of Medicine, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
⁵ Department of Medicine, Division of Cardiology, Sinai Health System and Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada.

PMID: 31727290
DOI: 10.1016/j.jacc.2019.09.022

Abstract

Poorly controlled type 2 diabetes mellitus is associated with the development of cardiovascular and renal complications, resulting in significant morbidity and mortality. Intensive glycemic control has been a major focus for clinical trials and novel drug development. However, narrow treatment strategies developed strictly for glycemic control did not confer a large risk reduction in cardiovascular events. There were also only modest effects in reducing the progression of diabetic kidney disease. Recent cardiovascular safety trials and the dedicated renal protection trial CREDENCE (Canagliflozin on Renal and Cardiovascular Outcomes in Participants with Diabetic Nephropathy) have shown that the sodium-glucose cotransporter-2 (SGLT2) inhibitors, a newer generation of antihyperglycemic agents, improve both cardiovascular and renal outcomes when added to guideline-recommended treatment. This review examines the current evidence on the mechanism underlying the cardiorenal effects of SGLT2 inhibitors and summarizes clinical trial evidence and safety data related to the use of SGLT2 inhibitors for cardiovascular and renal protection.

Keywords: antihyperglycemic; diabetes; diabetic kidney disease; heart failure.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Diabetes Mellitus, Type 2 / complications*
Diabetes Mellitus, Type 2 / drug therapy*
Diabetic Cardiomyopathies / prevention & control*
Diabetic Nephropathies / prevention & control*
Humans
Sodium-Glucose Transporter 2 Inhibitors / therapeutic use*

Substances

Sodium-Glucose Transporter 2 Inhibitors