A 70-year-old man with type 2 diabetes and heart failure with reduced ejection fraction (HFrEF) is started on dapagliflozin. Beyond glucose lowering, dapagliflozin provides cardiovascular benefit in HFrEF primarily through which mechanism?
- A Osmotic diuresis and natriuresis reducing preload and cardiac wall stress ✓
- B Positive inotropic effect by increasing intracellular calcium in cardiomyocytes
- C Inhibition of the renin-angiotensin-aldosterone system
- D Reduction of afterload by direct vasodilation of arteriolar smooth muscle
Correct answer: A. Osmotic diuresis and natriuresis reducing preload and cardiac wall stress
Explanation
SGLT2 inhibitors reduce heart failure hospitalizations by promoting osmotic diuresis and natriuresis, which lowers intravascular volume and cardiac preload. This hemodynamic effect is independent of glycemic control. They do not have direct inotropic effects or significant direct vasodilatory action. RAAS inhibition is the mechanism of ACE inhibitors.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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