Discussion
Instances of doping, as well as other forms of cheating, have been documented throughout the history of sports. The utilization of performance-enhancing drugs in sports is an obvious crisis. The utilization of substances in professional sports and competitions has significantly damaged the reputation of numerous athletes worldwide, while also posing a threat to their health. [7] The pharmaceutical industry has had significant expansion in the past decade, in tandem with advancements in technology. This growth has resulted in key advancements, particularly in the field of cardiac medications. The recently introduced cardiac medications may enhance sports performance and therefore may be abused as a form of doping. Therefore, our study aimed at examining the impact of dapagliflozin and sacubitril/valsartan, known for their significant symptomatic alleviation and favorable prognosis, particularly in heart failure, on sports performance. Both drugs have proved the ability to improve athletic performance, The impact on improving athletic performance was significantly more prominent for dapagliflozin.
The effect of exercise on the heart can be observed more quickly in rat. [8] The change seen in the echo data of the control group regarding the left ventricle is compatible with the development of an athlete’s heart. This demonstrates the methodological reliability of the experiment. In both medical approaches, there was a significant increase in antegrade flow of the pulmonary artery, compared to baseline. This may be related to an increase in right ventricular functions. Another notable feature is the increase of ejection fraction (EF) observed in the sacubitril/valsartan group. The increase in EF with sacubitril/valsartan use can also be seen in heart failure patients. [9] The effect of dapagliflozin on athletic performance was assessed independently from its impact on EF.
There was a decrease in the weight of the rat in all three groups due to intense exercise throughout the experiment. But there was no significant difference between the groups in this decrease. The decrease in weight is related to both the direct effect of physical activity on energy expenditure and the increase in metabolic rate during the resting period. [10] The rat were not under any calorie restriction. They had unrestricted access to food. If the experimental period was extended, a plateau in their weight could be observed. [11]
We observed an increase in rotarod results compared to baseline data in both medication groups. There was no significant difference compared to the control group. The adaptation of rat should not be ignored. However, while there is a statistical difference in the medication groups, although there is an increase in the control group, it is not statistically significant. These results may be the beginning of more comprehensive studies. Because the positive effect of dapagliflozin and sacubitril/valsartan on the rotarod may provide an advantage in skill sports (golf, table tennis, shooting, curling, bowling etc.). [12]
The primary objective of our investigation was to reveal the improvement in athletic performance. After similar results were obtained during the first 9 swimming sessions of exercise, we observed a significant difference in the athletic performance of rat with both medications. This effect of sacubitril/valsartan was generally observed parallel to the control group and slightly better. Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, enhances the natriuretic peptide system by suppressing the neprilysin enzyme and inhibits the renin-angiotensin-aldosterone system by inhibiting the angiotensin II receptor. Evidence demonstrates that it improves mortality and reduces hospitalization rates in individuals with heart failure caused by impaired left ventricular systolic performance. [13] Also sacubitril/valsartan augments the effects of bradykinin, substance P, and adrenomedullin, which are other hormones that may contribute to the cardiac efficacy of the medication. [14] The positive effect of sacubitril/valsartan on athletic performance may be related to increased cardiac efficiency and slightly improved left ventricular function. However, this effect was observed to be limited and there was a relative increase in athletic performance.
The effect of dapagliflozin was observed remarkably. Sodium-glucose cotransporter-2 (SGLT) inhibitors reduce the risk of hospitalization for heart failure in patients with either preserved or reduced ejection fraction. However, the specific hemodynamic processes responsible for these advantages are not yet fully understood. [15] A research conducted on rat has demonstrated that dapagliflozin has a vasodilatory impact on the thoracic aorta, which is dependent on the voltage of potassium channels. [16] This demonstrated a direct effect on vascular cells for both acute and chronic treatment. [17] Therefore, it is reasonable to observe that the improvement in performance begins during the initial periods and thereafter advances throughout time. Another possible mechanism of action may be related to its positive microvascular and endothelial activity. [18] SGLT-2 inhibitors, currently the only option in preserved EF heart failure, may have as yet undisclosed abilities regarding possible cellular myocardial efficiency. However, our study showed that dapagliflozin has an obvious doping effect on athletic performance. Future studies on the mechanism of action may reveal the reasons for this effect more clearly.