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Armillotta M, Angeli F, Paolisso P, Belmonte M, Raschi E, Di Dalmazi G, Amicone S, Canton L, Fedele D, Suma N, Foà A, Bergamaschi L, Pizzi C. Cardiovascular therapeutic targets of sodium-glucose co-transporter 2 (SGLT2) inhibitors beyond heart failure. Pharmacol Ther 2025; 270:108861. [PMID: 40245989 DOI: 10.1016/j.pharmthera.2025.108861] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 02/12/2025] [Accepted: 04/14/2025] [Indexed: 04/19/2025]
Abstract
Sodium-glucose co-transporter 2 (SGLT2) inhibitors are oral antidiabetic agents that have shown significant improvements in cardiovascular and renal outcomes among patients with heart failure (HF), regardless of diabetic status, establishing them as a cornerstone therapy. In addition to glycemic control and the osmotic diuretic effect, the inhibition of SGLT2 improves endothelial function and vasodilation, optimizing myocardial energy metabolism and preserving cardiac contractility. Moreover, SGLT2 inhibitors may exhibit anti-inflammatory properties and attenuate acute myocardial ischemia/reperfusion injury, thereby reducing cardiac infarct size, enhancing left ventricular function, and mitigating arrhythmias. These pleiotropic effects have demonstrated efficacy across various cardiovascular conditions, ranging from acute to chronic coronary syndromes and extending to arrhythmias, valvular heart disease, cardiomyopathies, cardio-oncology, and cerebrovascular disease. This review provides an overview of the current literature on the potential mechanisms underlying the effectiveness of SGLT2 inhibitors across a wide range of cardiovascular diseases beyond HF.
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Affiliation(s)
- Matteo Armillotta
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy; Cardiovascular Division, Morgagni-Pierantoni University Hospital, Forlì, Italy
| | - Francesco Angeli
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy; Cardiovascular Division, Morgagni-Pierantoni University Hospital, Forlì, Italy
| | | | - Marta Belmonte
- Cardiology Unit, Sant'Andrea University Hospital, Rome, Italy; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Emanuel Raschi
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Guido Di Dalmazi
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy; Division of Endocrinology and Diabetes Prevention and Care Unit, IRCCS, University Hospital of Bologna, Bologna, Italy
| | - Sara Amicone
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy; Cardiovascular Division, Morgagni-Pierantoni University Hospital, Forlì, Italy
| | - Lisa Canton
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy; Cardiovascular Division, Morgagni-Pierantoni University Hospital, Forlì, Italy
| | - Damiano Fedele
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy; Cardiovascular Division, Morgagni-Pierantoni University Hospital, Forlì, Italy
| | - Nicole Suma
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy; Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
| | - Alberto Foà
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy; Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
| | - Luca Bergamaschi
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy; Cardiovascular Division, Morgagni-Pierantoni University Hospital, Forlì, Italy
| | - Carmine Pizzi
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy; Cardiovascular Division, Morgagni-Pierantoni University Hospital, Forlì, Italy.
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Abbas MT, Awad K, Farina JM, Tamarappoo BK, Lee KS, Lester SJ, Alsidawi S, Sell-Dottin KA, Ayoub C, Arsanjani R. The Association Between Sodium-Glucose Cotransporter 2 Inhibitors and Bioprosthetic Aortic Valve Degeneration. JACC. ADVANCES 2025; 4:101750. [PMID: 40286382 DOI: 10.1016/j.jacadv.2025.101750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Revised: 03/24/2025] [Accepted: 03/30/2025] [Indexed: 04/29/2025]
Affiliation(s)
| | - Kamal Awad
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Juan M Farina
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Kwan S Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Steven J Lester
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Said Alsidawi
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Chadi Ayoub
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA.
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Ong JYS, Tan SML, Koh AS, Kong W, Sia CH, Yeo TC, Quek SC, Poh KK. Novel Circulating Biomarkers in Aortic Valve Stenosis. Int J Mol Sci 2025; 26:1902. [PMID: 40076529 PMCID: PMC11899762 DOI: 10.3390/ijms26051902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2024] [Revised: 02/14/2025] [Accepted: 02/20/2025] [Indexed: 03/14/2025] Open
Abstract
The underlying pathophysiology of aortic stenosis and factors affecting its clinical progression remain poorly understood. Apart from B-type natriuretic peptide (BNP), novel and emerging biomarkers have been described in association with aortic stenosis, emphasising the potential for these biomarkers to illuminate on yet unknown mechanisms of its pathogenesis. In this review, we aimed to summarise what is known about aortic stenosis biomarkers, highlight the emerging ones, and provide a roadmap for translating these insights into clinical applications. Among the biomarkers studied, lipoprotein(a) [Lp(a)] has emerged as the most promising for risk stratification. Elevated Lp(a) levels are often associated with more rapid aortic stenosis progression. This detrimental effect is attributed to its role in promoting valve calcification. While other emerging biomarkers such as matrix metalloproteinases, monocytes, and metabolites show promises, their specific roles in aortic stenosis pathophysiology remain less clear. This may be due to their relatively recent discovery. Ongoing research aims to elucidate their mechanisms of action.
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Affiliation(s)
- Joy Yi-Shan Ong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (J.Y.-S.O.); (S.M.L.T.)
| | - Sarah Ming Li Tan
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (J.Y.-S.O.); (S.M.L.T.)
| | - Angela S. Koh
- National Heart Centre Singapore, Singapore 169609, Singapore
- DUKE-NUS Medical School, Singapore 169857, Singapore
| | - William Kong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (J.Y.-S.O.); (S.M.L.T.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Ching Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (J.Y.-S.O.); (S.M.L.T.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Tiong Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (J.Y.-S.O.); (S.M.L.T.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Swee Chye Quek
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (J.Y.-S.O.); (S.M.L.T.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (J.Y.-S.O.); (S.M.L.T.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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Mukeshimana G, Marchandot B, Mutabazi V, Lazeras C, Nsengiyumva C, Anh Mai T, Nguyen QN, Pham HM, Pibarot P, Morel O, Rwanda RHD Research Network. Rwanda RHD Research Network: Central Hub for International Collaborative Efforts to Tackle Rheumatic Heart Disease. JACC. ADVANCES 2024; 3:101216. [PMID: 39817099 PMCID: PMC11733990 DOI: 10.1016/j.jacadv.2024.101216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Affiliation(s)
| | - Benjamin Marchandot
- Department of Cardiology, University Hospital of Strasbourg, Strasbourg, France
- Research Unit 3074-Translational Cardiovascular Medicine, University of Strasbourg, Strasbourg, France
| | - Vincent Mutabazi
- Ministry of Health, Kigali, Rwanda
- African Field Epidemiology Network (AFENET), Kampala, Uganda
| | | | | | - Trung Anh Mai
- Vietnam National Heart Institute, Bach Mai hospital, Hanoi, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam
| | - Quang Ngoc Nguyen
- Vietnam National Heart Institute, Bach Mai hospital, Hanoi, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam
| | - Hung Manh Pham
- Vietnam National Heart Institute, Bach Mai hospital, Hanoi, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam
| | - Philippe Pibarot
- Canada Research Center in Valvular Heart Diseases, Université Laval, Québec, Canada
| | - Olivier Morel
- Department of Cardiology, University Hospital of Strasbourg, Strasbourg, France
- Research Unit 3074-Translational Cardiovascular Medicine, University of Strasbourg, Strasbourg, France
- Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam
- GERCA (Groupe pour l’Enseignement et la Recherche Cardiologique en Alsace), Strasbourg, France
| | - Rwanda RHD Research Network
- Department of Cardiology, King Faisal Hospital, Kigali, Rwanda
- Department of Cardiology, University Hospital of Strasbourg, Strasbourg, France
- Research Unit 3074-Translational Cardiovascular Medicine, University of Strasbourg, Strasbourg, France
- Ministry of Health, Kigali, Rwanda
- African Field Epidemiology Network (AFENET), Kampala, Uganda
- Expertise France, Paris, France
- Vietnam National Heart Institute, Bach Mai hospital, Hanoi, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam
- Canada Research Center in Valvular Heart Diseases, Université Laval, Québec, Canada
- GERCA (Groupe pour l’Enseignement et la Recherche Cardiologique en Alsace), Strasbourg, France
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Gasior T. 2024 Update on Cerebral Embolic Protection After Transcatheter Aortic Valve Replacement. J Clin Med 2024; 13:7256. [PMID: 39685715 DOI: 10.3390/jcm13237256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Revised: 11/25/2024] [Accepted: 11/27/2024] [Indexed: 12/18/2024] Open
Abstract
Cerebral embolic protection (CEP) during transcatheter aortic valve replacement (TAVR) has emerged as an important tool in reducing stroke risk associated with this intervention. With the recent expansion of TAVR into lower-risk populations, the role of preventive strategies gained greater significance. Despite advancements in TAVR technologies, peri-procedural stroke remains a significant complication, with rates ranging between 2 and 5%. CEP devices, introduced at the time of the procedure, have been developed to capture embolic debris and reduce the risk of neurological events. However, while MRI-detected embolic debris is commonly captured by these devices, the clinical benefit in reducing stroke remains debated. This review provides a comprehensive analysis of recent advances in relevant clinical research and CEP device development, offering recommendations for future studies to improve patient outcomes.
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Affiliation(s)
- Tomasz Gasior
- Collegium Medicum-Faculty of Medicine, WSB University, 41-300 Dabrowa Gornicza, Poland
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Ma W, Zhou T, Tang S, Gan L, Cao Y. Advantages and disadvantages of targeting senescent endothelial cells in cardiovascular and cerebrovascular diseases based on small extracellular vesicles. Expert Opin Ther Targets 2024; 28:1001-1015. [PMID: 39475108 DOI: 10.1080/14728222.2024.2421760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 10/23/2024] [Indexed: 12/13/2024]
Abstract
INTRODUCTION With the growth of the aging population, age-related diseases have become a heavy global burden, particularly cardiovascular and cerebrovascular diseases (CVDs). Endothelial cell (EC) senescence constitutes an essential factor in the development of CVDs, prompting increased focus on strategies to alleviate or reverse EC senescence. AREAS COVERED Small extracellular vesicles (sEVs) are cell-derived membrane structures, that contain proteins, lipids, RNAs, metabolites, growth factors and cytokines. They are widely used in treating CVDs, and show remarkable therapeutic potential in alleviating age-related CVDs by inhibiting or reversing EC senescence. However, unclear anti-senescence mechanism poses challenges for clinical application of sEVs, and a systematic review is lacking. EXPERT OPINION Targeting senescent ECs with sEVs in age-related CVDs treatment represents a promising therapeutic strategy, with modifying sEVs and their contents emerging as a prevalent approach. Nevertheless, challenges remain, such as identifying and selectively targeting senescent cells, understanding the consequences of removing senescent ECs and senescence-associated secretory phenotype (SASP), and assessing the side effects of therapeutic sEVs on CVDs. More substantial experimental and clinical data are needed to advance clinical practice.
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Affiliation(s)
- Wen Ma
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China
- Department of Emergency Medicine and Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China
- Disaster Medical Center, Sichuan University, Chengdu, China
| | - Tingyuan Zhou
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China
- Department of Emergency Medicine and Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China
- Disaster Medical Center, Sichuan University, Chengdu, China
| | - Songling Tang
- Department of Emergency Medicine and Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China
- Disaster Medical Center, Sichuan University, Chengdu, China
| | - Lu Gan
- Department of Emergency Medicine and Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China
- Disaster Medical Center, Sichuan University, Chengdu, China
| | - Yu Cao
- Department of Emergency Medicine and Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China
- Disaster Medical Center, Sichuan University, Chengdu, China
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