For patients with HF with mildly reduced or preserved ejection fraction, the sodium glucose cotransporter 2 (SGLT2) inhibitor dapagliflozin reduces the combined risk for worsening HF or cardiovascular death, according to a study published in the New England Journal of Medicine. Scott David Solomon, MD, and colleagues randomly assigned 6,263 patients with HF and a left ventricular ejection fraction of more than 40% to receive either dapagliflozin or matching placebo in addition to usual therapy. The primary outcome, assessed in a time-to-event analysis, was a composite of worsening HF or cardiovascular death. The primary outcome occurred in 16.4% of 3,131 patients in the dapagliflozin group and in 19.5% of 3,132 patients in the placebo group (HR, 0.82; 95% CI, 0.73 0.92). Worsening HF occurred in 11.8% and 14.5% of patients in the dapagliflozin and placebo groups, respectively (HR, 0.79; 95% CI, 0.69-0.91), and cardiovascular death occurred in 7.4% and 8.3%, respectively (HR, 0.88; 95% CI, 0.74-1.05). Compared with the placebo group, total events and symptom burden were both lower in the dapagliflozin group. “These data provide further evidence to support the use of an SGLT2 inhibitor as essential therapy in patients with [HF], regardless of the presence or absence of type 2 diabetes mellitus or left ventricular ejection fraction,” Dr. Solomon and colleagues wrote.
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