1) Welcome to a Tweetorial on #SGLT2i & CV health. “Flozinators of the world, unite!” Accredited for 0.50h by @academiccme: #physicians, #nurses, #pharmacists. I am @mvaduganathan . . . pic.twitter.com/2yfGOqmStm
— cardio-met (@cardiomet_CE) May 25, 2021
2) The sodium-glucose cotransporter-2 inhibitors (#SGLT2i) have been firmly established as a cornerstone in high-risk primary and secondary prevention of CV and kidney disease. After 10 large-scale #RCTs, the “-flozins” are one of the best studied cardio-renal-metabolic Rx.
— cardio-met (@cardiomet_CE) May 25, 2021
4) The answer is choice 4. Three large-scale RCTs (#DAPAHF, #EMPERORReduced, #DAPACKD) have evaluated patients without T2D including prediabetes, however all required pts to have established #HF or #CKD.
— cardio-met (@cardiomet_CE) May 25, 2021
6) Although many are in various phases of development worldwide, there are 4 @US_FDA approved #SGLT2i (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin). These compounds have variable selectivity for the kidney #SGLT2 and gut #SGLT1. Source PMID: 29042751 pic.twitter.com/mFPGOcKIw9
— cardio-met (@cardiomet_CE) May 25, 2021
8) Mark your best answer and return tomorrow for the answer and more education! #FOAMed @KismetRasmu @pabeda1 @kidneyboy @DaveDixonPharmD @kamleshkhunti @NMHheartdoc @hvanspall @mirvatalasnag @djc795 @EiranGorodeski @AndrewJSauer @JohnRMontford @dr_benoy_n_shah @AnastasiaSMihai
— cardio-met (@cardiomet_CE) May 25, 2021
10) As to our poll from yesterday, #SGLT2i reduced risks of hospitalization for #HF by ~30% without heterogeneity by drug within class. More modest reductions in #ASCVD events were observed. pic.twitter.com/Yjdz5NvFzx
— cardio-met (@cardiomet_CE) May 26, 2021
12) While *prevention* of HF in at-risk individuals with #T2D was established in initial RCTs, subsequent trials pursued whether #SGLT2i may be important in the *treatment* of HF, even among those without #T2D
— cardio-met (@cardiomet_CE) May 26, 2021
14) An additional RCT, #SOLOISTWHF, by @DLBHATTMD et al showed benefits of sotagliflozin when initiated before or shortly after hospital discharge for #WorseningHF. Concordant signals of benefits were observed across the LVEF spectrum, including in the sample with #HFpEF. #ACC21 pic.twitter.com/R7XwX4oagl
— cardio-met (@cardiomet_CE) May 26, 2021
16) So how do #SGLT2i work in preventing & treating HF? While #SGLT2 transporters are not expressed in the myocardium, a number of #cardioprotective mechanisms have been proposed . . .
— cardio-met (@cardiomet_CE) May 26, 2021
18) In several carefully designed mechanistic evaluations (including by @SantosGallegoMD @matthewmylee @MassarOmard), #SGLT2i have been shown to promote favorable LV reverse remodeling. These benefits were observed in pts with and without T2D. pic.twitter.com/HMjvxiicOY
— cardio-met (@cardiomet_CE) May 26, 2021
20) However, most patients in HF RCTs treated with an SGLT2i did not require changes in diuretic dosing. As such, anticipatory diuretic dose reduction is generally not needed for most@Kieranfdocherty @PSJhund @UoGHeartFailure pic.twitter.com/tHjCNLk7oM
— cardio-met (@cardiomet_CE) May 26, 2021
22) What is the most frequently observed adverse drug effect with #SGLT2i?
— cardio-met (@cardiomet_CE) May 26, 2021
24) Welcome back! Let's wrap up this accredited tweetorial on #SGLT2i and CV outcomes. I am @mvaduganathan. Where else can you learn on Twitter AND earn CE/#CME?? Follow us! #endotwitter #NephTwitter #nephjc @American_Heart @CarysBarton @PUNC14Julie
— cardio-met (@cardiomet_CE) May 27, 2021
26) Hypoglycemia is infrequent/rare with #SGLT2i as the glucosuric effects are attenuated when blood glucose levels are low. In fact, in RCTs of #SGLT2i, HbA1c lowering is negligible and serious hypoglycemia was comparable to placebo in those without diabetes.
— cardio-met (@cardiomet_CE) May 27, 2021
. . . avoiding excessive EtOH/ketogenic diets, and holding several days ahead of planned surgery.
— cardio-met (@cardiomet_CE) May 27, 2021
29) With appropriate pt selection & anticipatory guidance, #SGLT2i are well tolerated & represent a central Rx for cardio-renal-metabolic protection. While this Tweetorial focused on #CV benefits of this class, its role in promoting #kidney health is also well-established. pic.twitter.com/J5fdgD5QBT
— cardio-met (@cardiomet_CE) May 27, 2021
31) That's it! You made it! Free CE/#CME! Now go to https://t.co/RrniKyoP33 and claim your credit! I am @mvaduganathan. Follow @cardiomet_CE for more tweetorials, and visit us at https://t.co/U6Mo1oSwIh for unrolled programs where credit opportunity is still active!
— cardio-met (@cardiomet_CE) May 27, 2021