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CardioNerds Dr. Rick Ferraro, Dr. Gurleen Kaur, and Dr. Maryam Barkhordarian discuss the evidence and data supporting SGLT inhibition for cardiovascular and kidney health outcomes with expert faculty Dr. Muthu Vaduganathan. They discuss the role of SGLT inhibitors in different populations, including those with diabetes mellitus, heart failure, CKD, and myocardial infarction. Show notes and audio editing by CardioNerds Academy Fellow Dr. Maryam Barkhordarian.\n\n\n\nThis episode was produced in collaboration with the American Society of Preventive Cardiology (ASPC) with independent medical education grant support from Lexicon Pharmaceuticals. \n\n\n\n\n\n\n\n\n\n\n\nCardioNerds Prevention PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll\n\n\n\n\n\nCardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!\n\n\n\n\n\n\n\n\n\nPearls - The Data Supporting SGLT Inhibition with Dr. Muthiah Vaduganathan\n\n\n\n\nThe benefit of SGLT inhibition extends beyond diabetes, and improves cardiovascular and kidney health outcomes independent of diabetes in appropriate patient populations.\n\n\n\nSGLT inhibition decreases cardiovascular mortality and heart failure hospitalization independent of left ventricular ejection fraction.\n\n\n\nSGLT inhibitors reduce clinically relevant events such as dialysis and transplantation in CKD patients irrespective of etiology and are now a cornerstone for the prevention of CKD progression.\n\n\n\nThe introduction of polypills in heart failure can simplify GDMT implementation.\n\n\n\n\nShow notes - The Data Supporting SGLT Inhibition with Dr. Muthiah Vaduganathan\n\n\n\nHow did SGLT inhibitors transition from \u201cdiabetes medication\u201d to guideline-directed cardiovascular medicine?\n\n\n\n\nMost therapies in cardiology were developed for a particular purpose and ended up being indicated for a vastly different reason. The SGLT-2 inhibitors are no different.\n\n\n\nCardiovascular safety concerns about diabetes medications led to a mandate to conduct cardiovascular outcomes trials for all novel diabetes medications. This federal requirement shed light on the cardiovascular benefits of SGLT inhibitors in patients with diabetes.\n\n\n\nThese initial trials showed that not only are these medications safe but also, surprisingly, proved their role in preventing heart failure and delaying progression of chronic kidney disease.\n\n\n\n\nWhat are the mechanisms of action of SGLT-2 and SGLT-1/2 inhibitors?\n\n\n\n\nThe central mechanism(s) of how these medications confer health outcomes benefits patients is/are not well understood.\n\n\n\nThe main organ involved in the action of SGLT-2 inhibitors is the kidney at the level of the proximal tubule, impacting the cardiovascular system by handling salt and water and improving kidney efficiency. Conversely, SGLT-1/2 inhibitors also act at the level of the gut, the predominant location of the SGLT-1 cotransporter.\n\n\n\nTheir effects on the cardiovascular system are secondary, given there is no SGLT-1 or -2 cotransporters in the myocardium. These secondary effects can be impacted through blood pressure reduction, volume regulation, improved glycemic control, etc. to overall improve cardiovascular status.\n\n\n\nWhatever the underlying mechanisms, the empirical data for their use is strong and growing.\n\n\n\n\nWhat is the role of SGLT inhibitors in preventing CKD progression?\n\n\n\n\nRAAS inhibitors (ACE inhibitors and ARBs) have been the cornerstone of CKD management for the past two to three decades.\n\n\n\nSGLT inhibitors have been the first add-on to this background therapy.\n\n\n\nFour trials, DAPA-CKD, EMPA-CKD, CREDENCE, and the SCORED, investigated the effects of SGLT-2 and SGLT-1/2 inhibitors in patients with CKD with or without diabetes.\n\n\n\nThe outcomes of these trials include modifying the course of CKD and reducing events such as dialysis initiation and transplantation. These effects were regardless of participants\u2019 diabetic status, CKD etiology, or individual patient profile.