Heart Failure with Preserved Ejection Fraction and Obstructive Sleep Apnea: A Novel Paradigm for Additional Cardiovascular Benefit of SGLT2 Inhibitors in Subjects With or Without Type 2 Diabetes

After examining the complex interplay between heart failure (HF) in its various clinical forms, metabolic disorders like nonalcoholic fatty liver disease (NAFLD), and obstructive sleep apnea (OSA) syndrome, in this mini-review we described possible favorable effects of sodium–glucose cotransporter 2...

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Bibliographic Details
Published in:Advances in therapy 2022-11, Vol.39 (11), p.4837-4846
Main Authors: Monda, Vincenzo Maria, Gentile, Sandro, Porcellati, Francesca, Satta, Ersilia, Fucili, Alessandro, Monesi, Marcello, Strollo, Felice
Format: Article
Language:English
Subjects:
Animals
Cardiology
Diabetes Mellitus, Type 2 - complications
Diabetes Mellitus, Type 2 - drug therapy
Editorial
Endocrinology
Fatty Acids - pharmacology
Fatty Acids - therapeutic use
Glucose
Heart Failure - complications
Heart Failure - drug therapy
Humans
Internal Medicine
Medicine
Medicine & Public Health
Non-alcoholic Fatty Liver Disease - epidemiology
Oncology
Pharmacology/Toxicology
Rheumatology
Sleep Apnea, Obstructive - complications
Sleep Apnea, Obstructive - drug therapy
Sodium - pharmacology
Sodium - therapeutic use
Sodium-Glucose Transporter 2 Inhibitors - therapeutic use
Stroke Volume
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Summary:After examining the complex interplay between heart failure (HF) in its various clinical forms, metabolic disorders like nonalcoholic fatty liver disease (NAFLD), and obstructive sleep apnea (OSA) syndrome, in this mini-review we described possible favorable effects of sodium–glucose cotransporter 2 inhibitors (SGLT2is) on HF with preserved (i.e., ≥ 50%) ejection fraction (HFpEF) through enhanced cardiorenal function and visceral-subcutaneous body fat redistribution. In greater detail, on the basis of pathophysiological mechanisms underlying OSA onset and the direct positive SGLT2i effect on renal function benefiting chronic kidney disease, we emphasized the promising role of SGLT2is in prevention, rehabilitation, and treatment of patients with OSA regardless of coexisting type 2 diabetes (T2DM). Indeed, SGLT2is enhance lipolysis and fatty acid beta-oxidation. These phenomena might prevent OSA by reducing the size of visceral and subcutaneous adipose tissue and, as proven in humans and animals with T2DM, counteract NAFLD onset and progression. The aforementioned mechanisms may represent an additional SGLT2i cardioprotective effect in terms of HFpEF prevention in patients with OSA, whose NAFLD prevalence is estimated to be over 50%.
ISSN:0741-238X
1865-8652
1865-8652
DOI:10.1007/s12325-022-02310-2