SGLT2 inhibitors cardioprotective

Aktuelle Buch-Tipps und Rezensionen. Alle Bücher natürlich versandkostenfre Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are the latest class of antidiabetic medication that inhibit the absorption of glucose from the proximal tubule of the kidney and hence cause glycosuria. Four SGLT2i are currently commercially available in many countries: canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin SGLT2 inhibitor can cause increase in blood ketone levels. Beta hydroxybutyrate (βOHB), which is well known ketone body associated with SGLT2 inhibitor, showed a protective effect against Dox in H9C2 cells and in Dox-treated mice. These results suggest elevating βOHB might be a convincing mechanism for the protective effects of SGLT2 inhibitor SGLT-2 inhibitors are a novel class of antidiabetic drugs which produce glycosuric and natriuretic effects by inhibiting glucose and sodium reabsorption from the proximal convoluted tubules [ 10 ]. Some SGLT-2 inhibitors, including canagliflozin, dapagliflozin and empagliflozin, have been approved for their use in Europe and the USA [ 11 ]

Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce cardiovascular mortality in patients with diabetes mellitus but the protective mechanism remains elusive. Here we demonstrated that the SGLT2 inhibitor, Empagliflozin (EMPA), suppresses cardiomyocytes autosis (autophagic cell death) to confer cardioprotective effects. Using myocardial infarction (MI) mouse models with and without. R ESEARCH ARTICLE Cardioprotective mechanism of SGLT2 inhibitor against myocardial infarction is through reduction of autosis Kai Jiang 1, Yue Xu , Dandan Wang , Feng Chen1, Zizhuo Tu1, Jie Qian , Sheng Xu , Yixiang Xu2, John Hwa3, Jian Li2, Hongcai Shang4, Yaozu Xiang1& 1 Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai 200092, Chin co-transporter (SGLT) 2 inhibitors (SGLT2i) have demonstrated cardioprotective e ects and reduction in CV outcomes [6]. The latest guidelines of the American Diabetes Association (ADA) for the management of hyperglycemia recommend a personalized approach [7]. CV disease and the presenc

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Results from current CVOTs show promise for SGLT‐2 inhibitors in the prevention of HF in patients with T2D across a spectrum of cardiovascular risk Guidelines strongly recommend an SGLT2 inhibitor or GLP-1 receptor agonist in patients with type 2 diabetes and manifestations of CVD or high risk for CVD. However, uptake of these cardioprotective drugs in 2020 remains low (<3% in a recent paper) glycaemic control underlie the cardioprotective effect seen with SGLT2-inhibitor therapy . However, there are key considerations worthy of discussion. Weight loss from SGLT2- inhibitor therapy occurs due to an increased glucagon:insulin ratio causing increased lipid mobilisation and is thought to be one of the mech decrease major adverse cardiovascular events (MACE), heart failure, and the progression of CKD. SGLT2 inhibitors increase urine volume and increase urogenital candida infections SGLT2 Inhibitors Produce Cardioprotective and Renoprotective Benefits by Inducing a State of Fasting Mimicry It is therefore noteworthy that SGLT2 inhibitors induce a transcriptional paradigm that closely mimics the cellular response to starvation (Fig. 1) (27)

SGLT2 Inhibitors: A Review of Their Antidiabetic and

  1. Cardioprotective Potential of an SGLT2 Inhibitor Against Doxorubicin-Induced Heart Failure Chang-Myung Oh, MD, PhD, 1, * Sungsoo Cho, MD, PhD, 2, * Ji-Yong Jang, MD, 3 Hyeongseok Kim, MD, PhD, 4 Sukyung Chun, MS, 1 Minkyung Choi, BS, 1 Sangkyu Park, MD, PhD, 5 and Young-Guk Ko, MD, PhD 6: 1 Division of Endocrinology and Metabolism, CHA Bundang Medical Center, School of Medicine CHA University.
  2. SGLT2 inhibitors also promote sodium metabolism-mediated cardioprotective effects. These compounds could reduce the intracellular sodium overload to improve mitochondrial energetics and oxidative defense in the heart through binding with NHE and/or SMIT1. Furthermore, SGLT2 inhibitors could modulate mitochondrial dynamics by regulating the.
  3. The recent developed drugs Sodium glucose transporter 2 inhibitors (SGLT2-Is), have action on diabetes as well as on kidney. Current research and studies have shown that SGLT2-Is attenuated the risk of cardiac complication associated with morbidity and hospitalization in diabetes patients
  4. Cardioprotective effect of SGLT2 inhibitors is due to reduction of plasma volume from continuous urine glucose excretion without activating renin angiotensin system and sympathetic nervous system. Therefore, SGLT2 inhibitors have a favorable effect on cardiac function as well as cardiac structure and hence, improvement of cardiovascular outcome

Cardioprotective Potential of an SGLT2 Inhibitor Against

Abstract. The cardioprotective effects of SGLT2 (sodium-glucose cotransporter 2) inhibitors may be related to their ability to induce a fasting-like paradigm, which triggers the activation of nutrient deprivation pathways to promote cellular homeostasis. The most distinctive metabolic manifestations of this fasting mimicry are enhanced. SGLT2 inhibitors cause a shift from glucose to fat oxidation and the end product of fatty acid oxidation is acetyl CoA, which either can enter the tricarboxylic acid cycle or be converted to ketones, the latter being favored by the SGLT2 inhibitor-induced stimulation of glucagon secretion (24,25) In conclusion, data from DAPA‐HF and EMPEROR‐Reduced trials suggest that SGLT2 inhibitor is a drug with both antidiabetic and cardioprotective properties. In the near future, its renal protection effect in patients with chronic kidney diseases will be revealed SGLT2-inhibitor therapies are a promising new class of drugs for treating type 2 diabetes and heart failure. The cardioprotective effect of SGLT2 inhibition has been demonstrated in models of diabetic cardiomyopathy, heart failure and ischaemic cardiomyopathy. The mechanism through which SGLT2-inhibitor therapy exerts its benefit in patients. These inhibitors prevent the progression of HF in patients with diabetes both directly and indirectly. However, it is not clear whether SGLT2 inhibitors have a cardiovascular benefit in patients without diabetes. In the present study, we aimed to determine whether empaglifozin, an SGLT2 inhibitor, has a protective role in HF without diabetes

SGLT2 inhibitors reduce CV endpoints most likely through a reduction of HF-related events. Prof. Marx discusses potential underlying mechanisms explaining the beneficial effects of this drug class on HF -SGLT2 inhibitors reduce cardiovascular endpoints in patients with diabetes and high CV risk most likely through a reduction of heart failure-related events -SGLT2 inhibition may prevent or delay the development of heart failure. -Various mechanisms seem to contribute to the beneficial effects of SGLT2 inhibitors on heart failur With clear and rapid-onset benefit upon cardiovascular outcomes, particularly in respect to heart failure rehospitalization, 1 SGLT2 inhibitors are rapidly becoming an essential part of the Cardiologist's pharmacopoeia. Remarkably, the mechanisms belying the cardioprotective effects of SGLT2 inhibitors remain obscure Clinical Evidence of the Cardioprotective Effects of SGLT2 Inhibitors. The EMPA-REG OUTCOME trial, a cardiovascular outcome trial (CVOT) of the SGLT2 inhibitor empagliflozin, demonstrated that empagliflozin was superior to a matching placebo in reducing cardiovascular events, including mortality and hospitalization for heart failure in patients with type 2 diabetes and established.

Although SGLT2-inhibitors have important cardioprotective effects in hyperglycemia, their underlying mechanisms are complex and not completely understood The sodium glucose cotransporter 2 (SGLT2) inhibitors are a class of drug that have been widely used in the management of type 2 diabetes mellitus that work by inhibiting the reabsorption of glucose in the proximal convoluted tubule SGLT2 Inhibitors Cardioprotective Mechanisms SGLT2i, either known as gliflozins, represent an effective and innovative treatment option for patients with T2DM. This class of drugs, beyond the simple glycemic control, has also been demonstrated effective in the management of medium to long-term DM2-related complications Cardioprotective effect of SGLT2 inhibitors is due to reduction of plasma volume from continuous urine glucose excretion without activating renin angiotensin system and sympathetic nervous system. Therefore, SGLT2 inhibitors have a favorable effect on cardiac function as well as cardiac structure and hence, improvement of cardiovascular outcom

Potential mechanisms responsible for cardioprotective

Of note, the addition of SGLT-2 inhibitors was more common in the placebo group, There are several drugs under investigation that may further expand the scope of cardioprotective drugs, including recent interest in 'dual incretin' therapies of both GLP-1 and glucose-dependent insulinotropic (GIP) hormone. A recently published human. The ability of SGLT2 inhibitors to exert cardioprotective effects on a cellular level is intriguing because the healthy or failing heart does not express SGLT2, 54 and SGLT2 inhibitors do not bind to cardiac tissue. 55 In contrast, cardiomyocytes have identifiable receptors for angiotensin II, norepinephrine, aldosterone, and natriuretic. SGLT2 inhibitors are evolving into a cardioprotective therapy that incidentally lowers blood glucose. Initially developed for the treatment of patients with diabetes, it may be that patients with heart disease or kidney disease have at least as much to gain. A large new body of research is now required to define the full potential of this class. The study outcome was prescription of a cardioprotective GLD, defined as initiation of any type of SGLT2 inhibitor or GLP-1 ana-logue. GLP-1 analogues were first introduced in Denmark in 2007 (exenatide), whereas the first SGLT2 inhibitor was introduced in 2012 (dapagliflozin). An overview of the GLP-1 analogues and SGLT2 inhibi

Cardioprotective mechanism of SGLT2 inhibitor against

  1. The results showed that SGLT2 inhibitors were associated with a lower risk of cardiac events in type 2 diabetics when compared to DPP-4 inhibitors. For example, the rate of heart failure was 3.1 events per 1,000 people among patients who took SGLT2s and 7.7 events per 1,000 people among patients who took DPP-4s
  2. Among patients with diabetes in the United States, researchers found that lower rates of SGLT2 inhibitor use, a medication with substantial cardioprotective and kidney protective benefits, is associated with Black race, Asian race, female gender, and lower household income. If left unaddressed, these inequities in [use] will continue to.
  3. controlled outcome trials showed that SGLT-2 inhibitors and GLP-1 receptor agonists are able t o reduce cardiovascular events and all-cause mortality, as well as progression of renal disease, in patients with type 2 DM. This document presents in detail the available evidence on the cardioprotective and nephroprotectiv
  4. Cardioprotective Effects for Sodium-Glucose Cotransporter-2 Inhibitors. Bruce Soloway, MD, reviewing Filion KB et al. BMJ 2020 Sep 23. Findings from a large observational study are consistent with results of randomized trials. In several randomized, controlled trials, sodium-glucose cotransporter-2 (SGLT-2) inhibitors lowered the incidence.
  5. . SGLT2 inhibitors promote erythropoiesis, presumably through SIRT1-mediated activation of hypoxia-inducible factor-2α, which is suppressed by metfor
  6. e if these benefits persist long term, the authors write. Several authors disclosed financial ties to the pharmaceutical industry. Abstract/Full Tex

Additionally, some SGLT2 inhibitors exhibit also SGLT1 inhibitory action possibly resulting in an attenuation of oxidative stress in ischemic myocardium (the SGLT1 inhibition hypothesis). Thus, many mechanisms have been suggested (and possibly act cumulatively) for the cardioprotective effects of SGLT2 inhibitors Blood pressure lowering. Hypertension is a prevalent modifiable risk factor for the development of heart failure. Because SGLT2 inhibitors lower blood pressure (), some of the beneficial effects of SGLT2 inhibitors in the setting of heart failure have been suggested to be related to this blood pressure improved cardiac energetics with SGLT2 inhibition lowering effect All the studies highlighted the cardioprotective effect of SGLT-2 inhibitors, especially empagliflozin, dapagliflozin, and canagliflozin in type 2 DM patients with established CV disease, but the studies could not find significant improvement in 3P-MACE (three-point major adverse CV event) indicators offered by these drugs except empagliflozin Drs Jennifer B. Green, Mikhail N. Kosiborod: Endocrine Society and Clinical Care Options (CCO) webinar on cardioprotective effects of SGLT2 inhibitors to reduce heart failure risk in patients with T2D. Jennifer B. Green, MD Mikhail N. Kosiborod, MD Physicians: maximum of 1.0 AMA. SGLT2 inhibitors had been shown to reduce the risk of heart failure hospitalization and chronic kidney effective cardioprotective drug for T2D in patients with cardiovascular or kidney diseas

Although SGLT2 inhibitors have several pleiotropic effects, the underlying mechanism responsible for their cardioprotective effects remains undetermined. In this regard, the absence of a nocturnal fall in blood pressure (BP), that is, non-dipping BP, is a common phenomenon in type 2 diabetes and has a crucial role in the pathogenesis of CV. Nevertheless, it is possible that SGLT2 inhibitors may exert a cardioprotective effect by inhibiting the deleterious actions of increased NHE-1 in a manner that is analogous to their effect to inhibit the increased activity of NHE-3 in the kidney. 76, 77 However, NHE inhibition may represent an indirect action that is related to other effects. Background: The present study investigated the possible cardioprotective effects of GLP1 and SGLT2i against diabetic cardiomyopathy (DCM) in type 2 diabetic rats and the possible underlying mechanisms. DCM is defined as the presence of heart failure in absence of coronary artery disease. Methods: Thirty-two male Sprague Dawley rats were randomly subdivided into 4 equal groups; a) control group.

Background: A chronic metabolic disease, diabetes mellitus (DM), is associated with various comorbidity due to cardiac complications that considerably decreasing the quality of life, but there is no specific medication for this. The recent developed drugs Sodium glucose transporter 2 inhibitors (SGLT2-Is), have action on diabetes as well as on kidney. Current research and studies have shown. Increases in hematocrit were noted in initial clinical trials of SGLT2 inhibitors and were thought to account, in part, for the cardioprotective effects of these medications.2, 3 The physiology of SGLT2 inhibitor-induced erythrocytosis is complex and remains to be fully elucidated, but postulated mechanisms include hemoconcentration, modulation. Evidence is emerging of at least four disparate pleiotropic effects of SGLT2 inhibitors that extend beyond their efficacy as oral antihyperglycaemic drugs, affecting tissues (brain and heart) that have negligible native SGLT2 expression. The first effect is the inhibition of the sodium-hydrogen exchanger (NHE) Considerable evidence shows sodium-glucose co-transporter-2 inhibitors have cardioprotective benefits, but new research elucidates the ways in which the drugs can also have positive renal impacts. Sodium-glucose co-transporter-2 inhibitors (SGLT2is) can improve cardiovascular and renal outcomes in patients with type 2 diabetes (T2D) , but the mechanisms by which it confers..

class of drug, mechanisms other than SGLT2 inhibition have been recently proposed. Thus, aim of this review is to assess the cardioprotective role of sodium glucose transporter 2 inhibitors (SGLT2i) in patients affected by both these conditions. 2. Heart Failure Pathophysiology in Type 2 Diabete Despite their glucose-lowering ability, pleiotropic effects and potential cardioprotective outcomes, the place of SGLT2 inhibitors in the management of type 2 diabetes is still hotly debated. To explain why, Lupsa and Inzucchi review the benefits and adverse effects of SGLT2 inhibitors approved for use in the USA and Europe in individuals with.

SGLT‐2 Inhibitors in Heart Failure: Current Management

New Insights into Prescribing of SGLT2 Inhibitors and GLP

New evidence of sodium-glucose cotransporter 2 inhibitors (SGLT2i) show an evolution toward improved outcomes with heart failure (HF) and chronic kidney disease (CKD) in patients both with and without type 2 diabetes (T2D).. A recent study, led by Roy Rasalam, MBBS, College of Medicine & Dentistry, James Cook University, reviewed randomized controlled trials to assess the effects of SGLT2. SGLT2 Inhibitors and Cardiovascular Outcomes : Current Perspectives and Future Potentials. / Jia, Xiaoming; Since the publications of the EMPA-REG and CANVAS trials, large multi-national cohort studies have further shown the cardioprotective effects of SGLT2i. Moreover, new studies examining SGLT2i action on sodium-hydrogen exchanger. Background: Randomized studies have shown that sodium-glucose cotransporter-2 inhibitors (SGLT2i) reduce major cardiovascular events in patients with type 2 diabetes mellitus. However, it is not known whether there are significant sex-based differences in the cardioprotective role of SGLT-2 inhibitors. Purpose: To investigate whether sex differences exist in reduction of major cardiovascular. Black patients, Asian patients and women with type 2 diabetes are less likely to be prescribed a SGLT2 inhibitor, while those with a household income of $100,000 or more have higher odds of. Singh M, Kumar A. Risks Associated with SGLT2 Inhibitors: An Overview. Curr Drug Saf. 2018;13:84-91. Crossref | PubMed; Grempler R, Thomas L, Eckhardt M, et al. Empagliflozin, a novel selective sodium glucose cotransporter-2 (SGLT-2) inhibitor: characterization and comparison with other SGLT-2 inhibitors. Diabetes Obes Metab 2012;14:83-90

1. Zelniker TA, Wiviott SD, Raz I, et al. SGLT2 inhibitors for primary andsecondary prevention of cardiovascular and renal outcomesin type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet. 2019;393:31-9. 2. Neuen BL, YoungT, Heerspink HJL, et al. SGLT2 inhibitors forthe preventionof kidne SGLT2 inhibitors play important roles in our new person-centric approach for managing T2D. Here's my take on how SGLT2 inhibitors can be used to mitigate cardiovascular and renal disease, along with how I approach treatment selection in challenging clinical scenarios

SGLT2 Inhibitors Produce Cardiorenal Benefits by Promoting

SGLT2 inhibitors and GLP-1 receptors provided CV benefits for adults with type 2 diabetes regardless of insulin use. SGLT2 inhibitors and GLP-1 agonists should be used as early as possible in. Background. Sodium-glucose co-transporter 2 (SGLT2) inhibitors are an arising drug class across antidiabetic therapeutics. During the last five years, large randomized trials have shown the cardioprotective effects of three SGLT2 inhibitors—empagliflozin, dapagliflozin, and canagliflozin—independently of the presence or absence of diabetes mellitus (DM) and within the first months after. INTRODUCTION. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, also known as gliflozins, constitute a novel class of oral antidiabetic drugs that specifically inhibit SGLT2 activity in the proximal tubule, thus preventing renal glucose reabsorption (14, 73).As glucose excretion increases, plasma glucose levels decrease, leading to favorable changes in all glycemic parameters while posing. SGLT2 inhibitors + cardioprotective, SGLT2 inhibitors + renoprotective. B. Selection Criteria Selected scientific journals meet the inclusion criteria as follows: 1) clinical studies, 2) patients with diabetes mellitus with comorbid cardiovascular and renal disorders, 3) SGLT2 inhibitor drugs compared with controls (placebo) or othe The findings revealed that the SGLT2 inhibitor class of drug had a better effect on a significant reduction in cardiovascular and renal event. The cardioprotective mechanism of SGLT2 inhibitors was related to sodium-hydrogen exchanger 1 (NHE1) in myocardium. While the renoprotective mechanism was related to the reduction of intraglomerular.

SGLT2 Inhibitors Play a Salutary Role in Heart Failure via

SGLT-2 Inhibitors: Ideal Remedy for Cardioprotection in

Effect of sodium glucose cotransporter 2 inhibitors on

In conclusion, SGLT2 inhibitor attenuates NLRP3 inflammasome activation, which might help to explain its cardioprotective effects. SGLT2 inhibitors, a class of type 2 diabetes medication, reduce. Ertugliflozin: Cardioprotective Effects on Epicardial Fat The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government

Cardioprotective Effects of Sirtuin-1 and Its Downstream

There is now convincing evidence from the cardiovascular outcome trials (CVOTs) of empagliflozin, canagliflozin and dapagliflozin that SGLT2 inhibitors can have a cardioprotective effect in people with type 2 diabetes. A summary of the cardiovascular findings from the CVOTs for empagliflozin, canagliflozin and dapagliflozin is presented in Table 2 SGLT-2 inhibitors linked to lower risk of cardiac events compared with DPP-4 inhibitors. A retrospective study of Canadian and British patients with type 2 diabetes found lower rates of cardiovascular death among those taking sodium-glucose cotransporter-2 (SGLT-2) inhibitors than in matched patients who took dipeptidyl peptidase-4 (DPP-4) inhibitors

Results: Based on the literature review, SGLT2 inhibitors do serve a statistically significant reno-protective function, as well as a cardioprotective function. However, the extent of the benefit gained from SGLT2 inhibitors is comparable to ACE inhibitors SGLT2 inhibitors SGLT2 inhibitors partially block the reabsorption of glucose in the proximal tubules in the kidney [31]. The members of this class have somewhat similar molecular structure but nevertheless possess differing relative selectivity for SGLT2 compared with SGLT1 [32]. Until recently, three SGLT2 inhibitors had been approved b

Autophagy stimulation and intracellular sodium reduction

The lower use of SGLT2 inhibitors among patients with HFrEF, ASCVD, and CKD is less than ideal because of the demonstrated cardioprotective and kidney-protective effects of this class of drugs. When the first clinical outcome trials on SGLT2 inhibitors (CANVAS, EMPA-REG, and DECLARE-TIMI) were published, it quickly became obvious that SGLT2 inhibitors were not merely glucose-lowering drugs.Yes, there were small decreases in HbA 1C (~0.5%), blood pressure (~2-5 mm Hg), and weight (~2-3 kg), but these modest effects could not fully explain the reduction in CV events and mortality This meta-analysis evaluated the effects of SGLT-2 inhibitors on cardiovascular outcomes in patients with T2DM and the results demonstrated that patients treated with SGLT-2 inhibitors, especially as add-on therapy, experienced significant cardioprotective effects and a potentially favorable outcome for all-cause mortality In all of the studies so far, the cardioprotective effects of the SGLT2 inhibitors have been in the context of standard therapy for diabetes. Some experts worry that greater use of the SGLT2 inhibitors among diabetes patients with cardiovascular disease will complicate treatment with unforeseen effects—and ratchet up costs

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In summary, our meta-analysis evaluated the effects of SGLT2 inhibitors on cardiovascular outcomes in patients with type 2 diabetes, and the results demonstrated that patients treated with SGLT2 inhibitors, especially as add-on therapy, experienced significant cardioprotective effects and a potential favorable outcome for all-cause mortality. Therefore, similar cardioprotective findings may be associated with canagliflozin and dapagliflozin, although the results are not available yet. It will be 3 to 4 years before the cardiovascular trials of the two other SGLT2 inhibitors -- canagliflozin (Invokana) and dapagliflozin (Farxiga) -- are finished Key advantages of SGLT2 inhibitors are their efficacy in treatment and prevention of heart failure, efficacy on top of excellent background therapy including ARNI (angiotensin receptor neprilysin inhibitor) blockade, rapid onset of benefit, efficacy independent of glycemic status and associated renal protection [5] © 2021 MJH Life Sciences and HCPLive - Clinical news for connected physicians. All rights reserved

Frontiers | SGLT2 Inhibitors Play a Salutary Role in Heart

In order to investigate the effects of SGLT2 inhibitors on liver function in Japanese patients with type 2 diabetes, a sub-analysis of canagliflozin in a Japanese clinical trial was performed [].In a sub-analysis of the phase 2 trial, ALT levels were significantly lower in the 12-week canagliflozin-treated group (n = 47) than in placebo (n = 59) in patients with abnormal ALT The authors concluded that short term use of SGLT2 inhibitors was associated with a decreased risk of cardiovascular events compared with the use of DPP-4 inhibitors. These findings suggest that SGLT2 inhibitors offer cardioprotective benefits among people with type 2 diabetes in a real world setting, although additional studies are needed to. In short, SGLT2 inhibitors should be prioritized in people with type 2 diabetes and a starting eGFR of >30 mL/min/1.73 m 2 to prevent progression of kidney disease, cardiovascular events, or both, especially in those with UACR >300 mg/g (Level A recommendation) Cardioprotective Effects of SGLT2s •SGLT 2 inhibitors have the potential for a significant role in cardioprotection (Empagliflozin indication) •Focus is also on non glycaemic effects of medications SGLT 2 inhibitor prescription requires careful thought and consideratio Modern antidiabetics, such as SGLT2 inhibitors, have shown positive effects on cardiovascular risks or kidney function for diabetics. However, recent study results show an equal benefit for heart failure patients regardless of their diabetes status