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

• Published in: Advances in therapy Vol. 39; no. 11; pp. 4837 - 4846
• Main Authors: Monda, Vincenzo Maria, Gentile, Sandro, Porcellati, Francesca, Satta, Ersilia, Fucili, Alessandro, Monesi, Marcello, Strollo, Felice
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01.11.2022
• 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; Heart failure; T2DM; Preserved ejection fraction; NAFLD; SGLT2is; Rehabilitation; Obstructive sleep apnea; Cardiorenal protection
• ISSN: 0741-238X; 1865-8652; 1865-8652
• DOI: 10.1007/s12325-022-02310-2

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%.