Sodium-glucose cotransporter 2 (SGLT2) inhibitors have repeatedly been shown to improve CV outcomes regardless of diabetes status, including the risk of hospitalization for heart failure (HHF), CV death and all-cause mortality.

These agents have been found to have a key role in reducing major adverse CV outcomes and HHF in patients both with and without diabetes. Some of the benefits observed in patients with HF could be attributed to the promotion of natriuresis and osmotic diuresis by these agents.

SGLT2 inhibitors decrease blood pressure without causing an increase in the heart rate and thus improve the myocardial workload. They also improve insulin sensitivity and glycemic control. By causing a reduction in insulin requirement, SGLT2 inhibitors promote weight loss, thus contributing to reduction in blood pressure.

SGLT2 inhibitors also have antifibrotic effects on the heart. Studies revealed that empagliflozin diminished cardiac myofibroblast activity and collagen remodelling. Dapagliflozin has also been shown to decrease myocardial fibrosis after myocardial infarction.

SGLT2 inhibitors benefit patients with HF regardless of their diabetes status. They have been reported to reduce mortality by 17% (as per some meta-analysis) and HHF by nearly one-third. The findings justify increased use of these agents in patients with reduced left ventricular ejection fraction (LVEF).

Considering their unique pathophysiological profile and significant benefit in CV profile, SGLT2 inhibitors have a pivotal role in the management of patients with HF.

Source: Tsampasian V, et al. Cardiol Res Pract. 2021;2021:9927533.