Prevention and Management of Heart Failure: Role of SGLT2 Inhibitors in Patients With and Without Diabetes

Certain antidiabetic therapies have adverse cardiovascular (CV) consequences. The recommendations for CV safety studies for new antidiabetic therapies led to the discovery that the sodium-glucose cotransporter-2 inhibitors (SGLT2is) have benefits in heart failure (HF) management. Mounting evidence from large, international, randomized, placebo-controlled trials have consistently demonstrated a reduction in hospitalizations for heart failure (HHF) among populations with type 2 diabetes or with HF with reduced ejection fraction. In vitro, animal and human studies have attempted to identify the cardioprotective mechanisms of SGLT2is, although these are not yet clearly defined. This review will summarize the major SGLT2i trials, which have resulted in valuable additions to CV care that are expected to significantly reduce both incident HF and established HF progression.