Серцева недостатність із збереженою фракцією викиду у хворих на цукровий діабет. Лікування інгібіторами натрій-глюкозного котранспортера-2

The prolonged physiological stress can lead to adverse cardiorenal complications, including cardiomyopathy, heart failure (HF), and chronic kidney disease (CKD). Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are approved for the treatment of type 2 diabetes mellitus (T2DM) and have demonstrated beneficial cardiorenal effects in patients with and without T2DM. Heart failure with preserved ejection fraction (HFpEF) is a multifaceted disease that results from a wide range of comorbidities. Obesity, hypertension, and diabetes mellitus are major risk factors for HFpEF. Clinical trial results demonstrate that morbidity and long-term mortality in patients with T2DM with HFpEF are higher than in patients without HFpEF. Inhibition of sodium-glucose cotransporter type 2 (SGLT-2) has been shown to reduce the reabsorption of filtered glucose in the proximal tubule, leading to glycosuria and a decrease in blood glucose levels through an insulin-independent mechanism. The beneficial effects of SGLT-2 inhibitors are due to reduced gluconeogenesis and improved insulin sensitivity, but are associated with increased glucagon response and insulin release from pancreatic β-cells. SGLT-2 inhibitors have been identified as potent antioxidant agents that may protect against oxidative damage by reducing free radical generation or activating the antioxidant system. Inhibition of SGLT-2-2 affects the nervous, cardiovascular and endocrine systems, leading to complex metabolic effects that go beyond simple glycemic control, contributing to the attenuation of myocardial remodeling and enhancing cardiovascular protection. Treatment with SGLT-2 inhibitors has been shown to reduce myocardial damage from oxidative stress and cardiac fibrosis. SGLT-2 inhibitors increase lipid mobilization and oxidation, increase plasma ketone body levels, and reduce tissue glucose uptake, improving cardiac function. The protective effects of SGLT-2 inhibitors on heart failure and its associated complications are partly due to their ability to reduce cytoplasmic sodium and calcium levels while increasing mitochondrial calcium. Thus, SGLT-2 inhibitors, by modulating sodium and calcium metabolism, improve calcium regulation and mitochondrial function, mitigating atrial remodeling and reducing the risk of arrhythmia in conditions such as heart failure and diabetes mellitus. The results of recent studies open up new possibilities in the treatment of patients with HF. The multiple effects of SGLT-2 inhibitors contribute to the improvement of the course of HF, reducing the risk of hospitalization for HF and improving the quality and duration of life.