The panacea for cardiovascular diseases: the role of statins in the management of heart failure

SGLT2 inhibition for outcomes: Is this the panacea?

The use of SGLT2 inhibitors, beyond present guideline-directed medical therapy for patients with type 2 diabetes, chronic kidney disease, high atherosclerotic cardiovascular risk and heart failure, may in the future become a significant addition to the treatment of patients with acute myocardial infarction. Ongoing studies, including the PREDOMINANCE trial, may prove beneficial with this class of agents, already demonstrated to improve outcomes in a wide range of patients, with and without type 2 diabetes. Cardiovascular specialists would benefit from increasing their familiarity with this proven therapeutic class in patients with cardiometabolic and cardiovascular disease and increase their utilization in appropriate patients.

Relative safety profiles of high dose statin regimens

Recent clinical trials recommend achieving a low-density lipoprotein cholesterol level of <100 mg/dl in high-risk and <70 mg/dl in very high risk patients. To attain these goals, however, many patients will need statins at high doses. The most frequent side effects related to the use of statins, myopathy, rhabdomyolysis, and increased levels of transaminases, are unusual. Although low and moderate doses show a favourable profile, there is concern about the tolerability of higher doses. During recent years, numerous trials to analyze the efficacy and tolerability of high doses of statins have been published. This paper updates the published data on the safety of statins at high doses.