HFpEF vs HFmrEF management 🏥 via #esc2023 #EBM

🔑 Clinical Trials:

🔹DELIVER (2022) and EMPEROR-Preserved (2021): SGLT2i in EF>40%
🔹PARAGON-HF (2019): ARNI vs ARB in EF>45%
🔹TOPCAT (2014): MRA in EF>45%
🔹CHARM-Preserved (2003): ARB in EF>40%

App 🔗 apps.apple.com/us/app/cardiac…

DM CKD stage 5にSGLT2iは有用？
10.7326/M23-1874

末期腎不全患者のSGLT2iの長期アウトカムは？
↓
🇹🇼データベース研究
2型DMでCKD stage 5患者
SGLT2i使用vs非使用
透析、心血管イベント、死亡リスク比較

結果：SGLT2i使用で
―透析、心不全入院、AMI、DKA、AKI↓
―全死亡→

🔴 Time to implement the #4pillars of “kidney GDMT”

✅RAS blockade
✅SGLT2i
✅ns-MRA
✅GLP-1 RA

✅Lifetime cardiovascular, kidney & mortality benefits of combination therapy in people with diabetes with albuminuria

ahajournals.org/doi/10.1161/CI…
#CardioEd #Cardiology #CardioTwitter

Real world data on #SGLT2i in advanced #CKD (eGFR below 20)

🔹Taiwan National Health Insurance Database

🔸76%⤵️ need for dialysis

🔹39%⤵️Acute MI💔

🔸20%⤵️AKI

🔹12%⤵️DKA‼️

⚠️residual bias may be present as RWE

🔗acpjournals.org/doi/10.7326/M2…

Cons of inpatient SGLT2i use. AACE
endocrinepractice.org/article/S1530-…

Pros of inpatient SGLT2i use. AACE
endocrinepractice.org/article/S1530-…

With FLOW trial presentation this month at #ERA24 , check out this Circulation On the Run podcast with Peder L. Myhre 🫀, Sandeep Das & me, discussing potential lifetime benefits of combination treatment with #4pillarsCKD : RASi, SGLT2i, ns-MRA & GLP-1RA

podcasts.apple.com/au/podcast/cir…

#kidneyGDMT

Session: management of #obesity
🔥Holistic care is key! Listen & help those with obesity seeking support. Exercise, resistance training, diet, weight reduction, lifestyle and psychological input alongside medical therapies (SGLT2i & GLP-1/GP agonists +/- bariatric surgery

@dirkmullerwieland on 2023 European Society of Cardiology diabetes guidelines
➡️Focus on CV risk prevention not just glucose lowering
➡️Give all pts GLP-1 RA & SGLT2i
➡️Reduce CV and kidney risk in #diabetes & #CKD eGFr & ACR (albuminuria =kidney damage before eGFR declines)
➡️New T2DM risk score

#HeartFailureDays
#HeartFailureWeek

#SGLT2i in #AcuteHF
#DICTATE_AHF
#Dapa confirmed:
-Effective decongestive effect ✅
-Diuretic & Natriuretic effect ✅
-Significant ⬇️ of mean loop-diuretic dose
-Shorter length of 🏥 ✅
-No AE ✅
🍀 On-top of SGLT2i ⬇️ of ☠️

#Findme
Gregg Fonarow MD

Los SGLT2i aumentan el suministro cardíaco de O2 y energía y disminuyen el trabajo cardíaco y citotoxicidad. Hay menor formación de toxinas como el p-cresol. La pérdida urinaria de calorías y glucosa aumenta lipólisis, por lo tanto, reduce la masa grasa.

doi.org/10.1093/ndt/gf…

SGLT2i safer than EPO for treatment of anemia in CKD ? What do you think ?

bit.ly/CJASN0362

最近はSGLT2iマンセーな試験ばかりで、
ひさしぶりにメトホルミンいいよね的な試験を見た気がする。

academic.oup.com/cid/advance-ar…

Sodium–Glucose Cotransporter-2 Inhibitors and the Risk for Dialysis and Cardiovascular Disease in Patients With Stage 5 Chronic Kidney Disease

SGLT2i use was associated with a lower risk for dialysis, cardiovascular events, DKA, and AKI

acpjournals.org/doi/10.7326/M2…

Join us this weekend for the Annual Turning the Tide on Diabetes Meeting. We have a great program and excellent speakers lineup! #CME #diabetes #SoMe #MedEd #heartfailure #SGLT2i #GLP1 #obesity #HFpEF #prevention

Welcome to day 1 of the Scripps Clinical Advances in Heart Failure, Arrhythmias, & Cardiogenic Shock Symposium! 🫀⚡️Rajeev Mohan gave a comprehensive update on HFpEF treatment, including SGLT2i’s & device-based therapies currently in clinical trials!

【SGLT2iが痛風リスク減少と関連（JAMA Intern Med）】

カナダの一般集団DB
メトホルミン投与中2型DM、PSマッチ3.4万人

SGLT2i vs SUで痛風発生HR 0.62（0.48～0.80）
痛風再燃も　HR 0.67（0.55〜0.82）
性別、年齢、利尿薬に関係なし

これはもう本当っぽいですね

pubmed.ncbi.nlm.nih.gov/38619822/

SGLT2i therapy should be offered to people withT2dm (green) ,should be considered (amber) ,should not be prescribed (red) #diabetes

Medical Therapies for Amyloid related HF: MRA and SGLT2i tend to be tolerated well

Routinely collected primary care data from UK:

Combination SGLT2i and GLP1-RA associated with reduction in risk of major cardiovascular events and serious renal events compared to either alone

From Laurent Azoulay & colleagues in The BMJ

bmj.com/content/385/bm…