Heart failure (HF) guidelines and practice have been quick to embrace the sodium-glucose cotransporter 2 (SGLT2) inhibitor drug class after DAPA-HF, EMPEROR-Reduced, and other trials suggested that, apparently as a class, they cut cardiovascular (CV) risk in patients with heart failure and reduced ejection fraction (HFrEF) both with and without diabetes. But how they achieve that is poorly understood, and such high-risk patients do not all seem to benefit to the same extent.
Now, a new analysis based on the CANVAS trial suggests that such patients most likely to respond to SGLT2-inhibitor therapy can potentially be identified by their profiles on a diverse assay panel targeting circulating biomarkers of myocardial injury and remodeling.
The more biomarkers that were elevated, the poorer the patients' outcomes in a post-hoc feasibility study based on the trial, which tested canagliflozin (Invokana, Janssen Pharmaceuticals) in patients with poorly controlled type 2 diabetes and a history of CV events or multiple other risk factors.
But also, the SGLT2 inhibitor's clinical benefit went up significantly with the number of elevated markers in the panel of three, each reflecting different mechanisms underlying the drug's effects. Patients with a rise in all three showed a 56% reduction in risk for major adverse cardiac events (MACE).
