Sodium-glucose cotransporter 2 inhibitors (SGLT2i) may improve clinical outcomes and health care usage in patients with transthyretin amyloid cardiomyopathy (ATTR-CM), according to a study published recently in The American Journal of Cardiology.
SGLT2 inhibitors have been found to benefit patients with heart failure with preserved ejection fraction, a condition that is physiologically similar to ATTR-CM. This class of medications may help reduce cardiac scar tissue, inflammation and oxidative stress, all of which are implicated in ATTR-CM, the study said.
What is ATTR-CM?
Transthyretin amyloidosis cardiomyopathy (ATTR-CM) is a rare progressive disease of the heart muscle that leads to congestive heart failure. It occurs when the transthyretin protein produced by the liver is unstable. Symptoms include fatigue; shortness of breath; irregular heart rate or palpitations; swelling of the legs, ankles and stomach; brain fog; wheezing; and dizziness. It often goes underdiagnosed because of a lack of awareness and knowledge of the disease. There is currently no cure for ATTR-CM.
“Addressing the critical therapeutic gaps in ATTR-CM remains a priority, and SGLT2 inhibitors represent a promising avenue for addressing these needs,” study authors said.
Read more about ATTR-CM therapies
Currently, tafamidis is among the few approved treatments for patients with ATTR-CM. While it is effective in reducing hospitalization related to cardiac events, as well as mortality, “tafamidis remains limited in its availability and is often prohibitively expensive, creating an urgent need to explore alternative and adjunctive therapies,” the study said.
The retrospective study included 623 patients with ATTR-CM who received SGLT2i and 623 patients who had not received it. Outcomes were analyzed over a period of five years, beginning from the date of SGLT2i initiation (SGLT2i cohort) or the date of ATTR-CM diagnosis (non-SGLT2i cohort).
The authors found that SGLT2i use was associated with reduced heart failure exacerbations, all-cause hospitalizations, critical care hospitalizations and acute kidney injury.
The group receiving SGLT2i had lower all-cause mortality than those not receiving the drug, but the association was not statistically significant. Nevertheless, the mortality rate in the SGLT2i group was 13.2%, compared to 27.3% in the non-SGLT2i group, suggesting a potential survival advantage that should be further investigated, the study said.
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