In adults with type 2 diabetes and advanced kidney disease, starting an SGLT2 inhibitor is linked to a 6% lower chance of developing heart failure than starting a GLP-1 receptor agonist, while the...
Mechanism
Synthesis from 1 study
SGLT2 inhibitors make the kidneys flush out more sugar and salt, which pulls water out of the blood and reduces the amount of fluid the heart has to pump. This lowers the strain on the heart and prevents heart failure. GLP-1 agonists don't do this same fluid removal, so they don't lower heart...
Most probable mechanism
SGLT2 inhibitors cause the kidneys to remove more sugar and salt from the blood, which pulls extra water out of the body. This reduces the amount of blood returning to the heart, making it easier for the heart to pump. The heart also uses less energy because it doesn't have to work as hard, which protects it from failure.
SGLT2 inhibitors block glucose and sodium reabsorption in the proximal tubule of the kidney
Increased delivery of glucose and sodium to the distal nephron triggers osmotic diuresis and natriuresis
Reduced plasma volume decreases venous return and left ventricular filling pressure
Lower preload reduces myocardial wall stress and oxygen consumption
Reduced cardiac workload lowers the risk of decompensation and heart failure
Evidence from Studies
Supporting (1)
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