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Dual-target strategy using SGLT2 inhibitors and ARNIs in HFrEF is safe and offers amplified protection against cardiovascular death and heart failure-related admissions.
Heart failure with reduced ejection fraction (HFrEF) continues to pose a global healthcare burden, despite innovations in therapy. A systematic review led by Prem Singh et al. underscores the potential benefits of integrating two breakthrough drug classes—sodium-glucose co-transporter 2 (SGLT2) inhibitors and angiotensin receptor-neprilysin inhibitors (ARNIs)—in tackling this complex condition.
Researchers conducted a comprehensive literature review across PubMed, Scopus, Embase, and Cochrane Central, adhering to PRISMA guidelines. The goal was to examine the therapeutic value, outcomes, and clinical efficiency of SGLT2 inhibitors and ARNIs, while also evaluating their combined impact. The analysis focused on randomized controlled trials published within the past decade. Out of the pool of literature, 5 high-quality trials met the stringent inclusion criteria.
Findings from the review show that both drug classes independently decrease cardiovascular mortality and hospitalizations due to heart failure. Importantly, data indicate that using SGLT2 inhibitors alongside ARNIs may further amplify clinical benefits. Although the synergistic effects were not primary outcomes in the included trials, consistent positive trends support the hypothesis.
SGLT2 inhibitors illustrated reliable effectiveness across key clinical endpoints, even in patients already receiving ARNI therapy. Both classes were linked with favorable safety profiles, enhancing their appeal for early and combined use in appropriate patient populations. The review bolsters current guideline-endorsed approaches favoring multidrug therapy for HFrEF and highlights the urgent need for future head-to-head trials to better define optimal sequencing and combination strategies.
Cureus
Comparative Effectiveness of Sodium-Glucose Co-transporter 2 (SGLT2) Inhibitors Versus Angiotensin Receptor-Neprilysin Inhibitors (ARNIs) in Heart Failure With Reduced Ejection Fraction: A Systematic Review
Prem Singh et al.
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