The Significance of DAPA-HF for Cardiovascular Care and Beyond

Mikhail Kosiborod, MD

To say that SGLT-2 inhibitor dapagliflozin has made great strides in cardiovascular care is an understatement.

Data has supported the drug’s ability to provide glycemic benefit among patients with diabetes, and recent trials have only bolstered its promise in improving cardiometabolic, cardiovascular, and renal outcomes.

Mikhail Kosiborod, MD, director of Cardiometabolic Research at Saint Luke's Mid America Heart Institute, and professor of Medicine at the University of Missouri-Kansas City, joined HCPLive® on an episode of the Heart Trials podcast to discuss the clinical impact of the DAPA-HF trial.

The 4744-participant study evaluated outcomes of dapagliflozin related to worsening heart failure or cardiovascular death. All patients had established heart failure with reduced ejection fraction with or without type 2 diabetes.

Interestingly, Kosiborod noted that previous trials have established heart failure risk in patients with diabetes, however no medications have ever been developed for the management of heart failure for these patients.

As such, the results from DAPA-HF may just represent a paradigm shift for this particular patient population. Results showed that dapagliflozin therapy reduced occurrence of composite cardiovascular and heart failure outcomes among patients, regardless of diabetes status.

Even more, the risk of heart failure hospitalization and/or cardiovascular-related death was notably higher at baseline for the study’s population.

Reflecting on these major findings, Kosiborod believed that the ripples of this trial will continue to be felt for conditions even beyond diabetes. For example, relatively recent findings have revealed nephroprotective effects as well as potential benefit for diabetic retinopathy.

In fact, this year, the US Food and Drug Administration (FDA) approved the drug for the treatment of chronic kidney disease in at-risk adults. Treatment was associated with reduced risk of kidney function decline, failure, and cardiovascular death and hospitalization for heart failure.

“I think the trial has had a lasting effect and will continue to have lasting effects,” Kosiborod said. “I think the care of patients with heart failure is going to be changed completely as a result of it.”

He noted that the study has raised additional questions, such as the types of heart failure and other noncommunicable diseases that can benefit from dapagliflozin treatment and the effects it may have on patients already in the hospital.

“What [this trial] ultimately taught us is that we should really think of SGLT2 inhibitors as drugs that provide organ protection. […] It’s still possible that we are just scratching the surface, and there may be additional disease entities where this medication will be helpful. I hope we don’t stop where we are and we continue the quest.”

Listen to Episode 2 of Heart Trials below: