Sodium-Glucose Cotransporter 2 Inhibitors and Mycotic Genital or Urinary Tract Infections in Heart Failure

Angela Duvalyan; Ricardo M La Hoz; Darren K McGuire; Mark H Drazner

doi:10.1016/j.cardfail.2024.04.009

Sodium-Glucose Cotransporter 2 Inhibitors and Mycotic Genital or Urinary Tract Infections in Heart Failure

J Card Fail. 2024 Apr 25:S1071-9164(24)00145-3. doi: 10.1016/j.cardfail.2024.04.009. Online ahead of print.

Authors

Angela Duvalyan¹, Ricardo M La Hoz², Darren K McGuire³, Mark H Drazner⁴

Affiliations

¹ Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Parkland Health and Hospital System, Dallas, Texas.
² Division of Infectious Disease & Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
³ Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Parkland Health and Hospital System, Dallas, Texas.
⁴ Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: mark.drazner@utsouthwestern.edu.

PMID: 38670430
DOI: 10.1016/j.cardfail.2024.04.009

Abstract

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) improve clinical outcomes in persons with heart failure (HF). This class of agents has been consistently associated with an increased risk of mycotic genital infections (MGIs), and in some, but not all, trials, urinary tract infections (UTIs). Other medications widely used for cardiac conditions do not cause MGIs and UTIs, so cardiologists and their supporting teams will be encountering clinical questions that they previously did not have to address. This review provides clinicians with practical recommendations about SGLT2i use in individuals with HF as related to the associated MGI and possible UTI risks. Overall, given the benefit of SGLT2is in clinical outcomes, the threshold for not initiating or discontinuing SGLT2is due to concerns for MGIs or UTIs should be high for persons with HF. Likewise, when SGLT2is are discontinued for such concerns, the threshold for reinitiation should be low.

Keywords: Adverse events; guideline-directed medical therapy; implementation; infectious disease; sex.

Publication types

Review