The Effects and the Mechanisms of Sodium Glucose Cotransporter-2 Inhibition in Heart Failure

Individuals with diabetes are not only with high risk of developing heart failure but also with increased risk of death [1]. Different types of hypoglycemic drugs have different cardiovascular safety, so it is necessary to evaluate the cardiovascular safety of new hypoglycemic drugs. In recent years, many large-scale randomized controlled trials on SGLT2 inhibitors for oral hypoglycemic agents such as (EMPA-REG OUTCOME (The Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes Trial); CANVAS Program (The Canagliflozin Cardiovascular Assessment Study Program); DEGLARE-TIMI 58 (The Dapagliflozin Effect on Cardiovascular Events -TIMI 58 Trial); DEFINE-HF Trial (The Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure Trial) have shown that SGLT2 inhibitors could significantly reduce the hospitalization rate and the composite endpoint of cardiovascular mortality in patients with heart failure compared to the placebo group [2-5]. This effect persisted even in non-diabetic patients. The mechanisms responsible for the cardioprotective effects of SGLT2 inhibitors remain uncertain. This article summarizes the possible mechanisms of SGLT2 inhibitors in heart failure as follows. The Biological Role of SGLT2