Emerging concepts in heart failure management and treatment: focus on SGLT2 inhibitors in heart failure with preserved ejection fraction

Dapagliflozin; Empagliflozin; Heart failureDapagliflozina; Empagliflozina; Atac de corDapagliflozina; Empagliflozina; Insuficiencia cardiacaThe role of sodium-glucose cotransporter 2 inhibitors (SLTG2i), developed initially as glucose-lowering agents, has represented a novelty in patients with heart failure (HF) and reduced ejection fraction (HFrEF) since dapagliflozin (DAPA-HF study) and empagliflozin (EMPEROR-Reduced study) were able to reduce morbidity and mortality in this setting regardless of the presence or absence of diabetes. In previous large clinical trials (EMPA-REG OUTCOME study, CANVAS, DECLARE-TIMI 58), SGLT2i have been shown to attenuate HF progression expressed by reducing the risk of HF hospitalizations in patients with type 2 diabetes mellitus mostly without HF at baseline. This benefit was then corroborated with positive results in HF outcomes (cardiovascular mortality and HF hospitalizations) in patients with HF with preserved ejection fraction (HFpEF) in the EMPEROR-Preserved (empagliflozin) and DELIVER (dapagliflozin) trials. Several biological mechanisms apart from the glycosuria are attributed to these agents in this last context, including anti-inflammatory effects, reduction of fibrosis and apoptosis, improvement of myocardial metabolism, mitochondrial function optimization, and oxidative stress protection. Moreover, SGLT2i can also improve ventricular loading conditions by forcing diuresis and natriuresis, and by enhancing vascular and renal function. In addition, SGLT2i can reduce myocardial passive stiffness (diastolic function) by enforcing the phosphorylation of myofilament modulatory proteins. This article provided an overview of the main pathophysiological characteristics of HFpEF and of the diverse mechanisms of action of SGLT2i in this setting. The supporting clinical evidence of SGLT2i in HFpEF (EMPEROR-Preserved and DELIVER trials) is also reviewed. This article is part of the Emerging concepts in heart failure management and treatment Special Issue: https://www.drugsincontext.com/special_issues/emerging-concepts-in-heart-failure-management-and-treatment

FACTORES DE RIESGO DE RETRASO DEL CRECIMIENTO EN NIÑOS DE 6 MESES A 5 AÑOS ATENDIDOS EN CONSULTA EXTERNA DEL HOSPITAL RODRÍGUEZ ZAMBRANO DE ENERO A JUNIO DEL AÑO 2005.

OBJETIVO: IDENTIFICAR LOS FACTORES DE RIESGO DE RETRASO DEL CRECIMIENTO EN NIÑOS DE 6 MESES A 5 AÑOS. MATERIAL Y MÉTODOS: ESTUDIO TRANSVERSAL DE CASOS Y CONTROLES EFECTUADO DE ENERO A JUNIO DEL 2005 EN CONSULTA EXTERNA DEL HOSPITAL RODRÍGUEZ ZAMBRANO DE LA CIUDAD DE MANTA. EN BASE AL TIPO DE CURVA DE CRECIMIENTO PRESENTADA SE DIVIDIÓ LA MUESTRA EN 2 GRUPOS.OBJETIVE: TO IDENTIFY THE FACTORS OF RISK LATE OF THE GROWTH IN CHILDREN OF 6 MONTHS TO 5 YEARS. MATERIAL AND METHODS: I STUDY TRAVERSE OF CASES AND MADE CONTROLS OF JANUARY TO JUNE OF THE 2005 IN EXTERNAL CONSULTATION OF THE HOSPITAL RODRÍGUEZ ZAMBRANO OF THE CITY OF MANTA, ECUSDOR. BASED ON THE TYPE OF PRESENTED CURVE OF GROWTH THE SAMPLE WAS DIVIDED IN 2 GROUPS