Shift of conventional paradigm of heart failure treatment: from angiotensin receptor neprilysin inhibitor to sodium-glucose co-transporter 2 inhibitors?

Abstract

Current clinical guidelines for heart failure (HF) contain a brand new therapeutic strategy for HF with reduced ejection fraction (HFrEF), which is based on neurohumoral modulation through the use of angiotensin receptor neprilysin inhibitors. There is a large body of evidence for the fact that sodium-glucose co-transporter 2 inhibitors may significantly improve all-cause mortality, cardiovascular mortality and hospitalization for HF in patients with HFrEF who received renin-angiotensin system blockers including angiotensin receptor neprilysin inhibitors, beta-blockers and mineralocorticoid receptor antagonists. The review discusses that sodium-glucose co-transporter 2 inhibitors have a wide spectrum of favorable molecular effects and contribute to tissue protection, improving survival in HFrEF patients. Lay Current clinical guidelines for heart failure (HF) contain a new therapeutic strategy for a certain type of HF. There is a large body of evidence for the fact that certain types of drugs called sodium-glucose co-transporter 2 inhibitors may significantly improve outcomes in patients with this type of HF who received a different group of drugs. The review discusses the features of sodium-glucose co-transporter 2 inhibitors that make them successful in improving the outcomes in patients with HF.