Dapagliflozin Therapy for Cardiovascular and Renal Benefits

Primary Indications for Dapagliflozin

The European Society of Cardiology recommends dapagliflozin for adults with type 2 diabetes who have either established cardiovascular disease or multiple cardiovascular risk factors, with strong benefits for reducing heart failure hospitalization and progression of kidney disease 1
Patients with documented atherosclerotic cardiovascular disease should receive dapagliflozin to reduce cardiovascular death and heart failure hospitalization, as recommended by the American Diabetes Association 1, 2
The DECLARE-TIMI 58 trial demonstrated a 17% reduction in the composite of cardiovascular death or heart failure hospitalization in patients with type 2 diabetes, as reported by the American Heart Association 3

Patients aged ≥55 years (men) or ≥60 years (women) with at least one additional risk factor qualify as high-risk and benefit from dapagliflozin, according to the American College of Cardiology 3
Additional risk factors include dyslipidemia, hypertension, current tobacco use, coronary/carotid/lower extremity artery stenosis >50%, left ventricular hypertrophy, eGFR <60 mL/min/1.73 m², or albuminuria, as defined by the European Society of Cardiology 3

The American College of Cardiology recommends dapagliflozin for all patients with heart failure and reduced ejection fraction (HFrEF), even without diabetes, to reduce hospitalization and cardiovascular mortality 1
Among patients with type 2 diabetes and existing heart failure, dapagliflozin provides particularly robust benefits, as reported by the European Society of Cardiology 1, 3

The National Kidney Foundation recommends dapagliflozin to reduce progression of diabetic kidney disease in patients with albuminuria or reduced eGFR, with benefits including reduced risk of sustained eGFR decline by 40% 1, 2
The renal benefits of dapagliflozin are consistent across all baseline blood pressure categories, including normotensive patients, as reported by the American Society of Nephrology 3

The cardiovascular and renal benefits of dapagliflozin occur independently of baseline HbA1c levels, including patients with HbA1c <7%, as stated by the American Diabetes Association 3
Treatment decisions should be made based on cardiovascular and renal risk, not glycemic targets alone, according to the European Association for the Study of Diabetes 2, 3

The American College of Cardiology recommends dapagliflozin to reduce the risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visits in adults with heart failure, regardless of diabetes status, with a dose of 10 mg once daily 4, 5
The American Diabetes Association supports the use of dapagliflozin to reduce the risk of hospitalization for heart failure in adults with type 2 diabetes mellitus and either established cardiovascular disease or multiple cardiovascular risk factors, with a dose of 10 mg once daily 5, 6
The American College of Cardiology suggests that dapagliflozin's cardiovascular and renal benefits appear to be independent of its glucose-lowering effects, as benefits are seen in patients with and without diabetes, with a dose of 10 mg once daily 4, 5

The DAPA-HF Trial demonstrated a 26% reduction in the composite of worsening heart failure or cardiovascular death in patients with heart failure with reduced ejection fraction, regardless of diabetes status, with a dose of 10 mg once daily 7
The DELIVER Trial showed an 18% reduction in the composite of worsening heart failure or cardiovascular death in patients with heart failure with preserved ejection fraction, with a dose of 10 mg once daily 4, 5
The DECLARE-TIMI 58 trial demonstrated cardiovascular safety and a 27% reduction in hospitalization for heart failure in patients with type 2 diabetes with established cardiovascular disease or multiple risk factors, with a dose of 10 mg once daily 5, 6

The American College of Cardiology recommends discontinuing dapagliflozin at least 3 days before planned surgery to prevent postoperative ketoacidosis, and monitoring for diabetic ketoacidosis, especially in patients with type 1 diabetes 8
The American College of Cardiology suggests assessing volume status before initiation and correcting volume depletion if present, and considering reducing diuretic dose if patient is at risk for volume depletion, with a dose of 10 mg once daily 8
Common adverse effects of dapagliflozin include genital fungal infections, urinary tract infections, and euglycemic diabetic ketoacidosis, with a dose of 10 mg once daily 8