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May 19, 2021

Could Flozins Be the Statins for Risk-Based Primary Prevention of Heart Failure?

Author Affiliations
  • 1Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA Cardiol. 2021;6(7):741-742. doi:10.1001/jamacardio.2021.1133

Heart failure (HF) accounts for nearly 1 million hospitalizations and more than 300 000 deaths annually. Emerging data support the benefit of a novel class of therapies, sodium-glucose cotransporter-2 inhibitors (SGLT2i), for treatment of HF with reduced ejection fraction and prevention of HF in individuals with diabetes or chronic kidney disease (CKD). However, SGLT2i have not yet been shown to lower HF risk in a broader population at risk for HF without diabetes or CKD. The narrative around flozins may sound familiar: it has striking parallels to the 1990s when the emergence of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or statins, shifted the focus from secondary prevention of atherosclerotic cardiovascular disease (ASCVD) to primary prevention in those at risk. In this Viewpoint, we synthesize available data for the role of SGLT2i in HF and propose a theoretical framework to evaluate flozins in primary prevention of HF akin to the role of statins in ASCVD (Figure).

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    2 Comments for this article
    pre-emptive medication in HF is not primary prevention
    Sok-Ja Janket, DMD, MPH | The Forsyth Institute
    The authors ignored the fact that HF patients are already quite sick with impaired cardiac functions. It is not the same as administering statins to those who had no other health issues except hypertension or mildly overweight. Adding any additional medications in HF patients must be carefully weighed for risk and benefit ratio.
    Flozins and heart failure
    Michael Plunkett, MD MBA | Practice/teaching
    One could argue Flozins are just expensive osmotic diuretics. With a generation of physicians being taught the erroneous concept of AKI, I have a feeling the standard care cohort was “lasix deficient” and therefore the flozins won vis a vis hospital admissions for CHF.