Sodium glucose cotransporter-2 inhibitors and heart disease: Current perspectives

Abstract

Sodium glucose cotransporter-2 inhibitors (SGLT-2i) are antidiabetic medications with remarkable cardiovascular (CV) benefits proven by multiple randomised controlled trials and real-world data. These drugs are also useful in the prevention of CV disease (CVD) in patients with diabetes mellitus (DM). Although DM as such is a huge risk factor for CVD, the CV benefits of SGLT-2i are not just because of antidiabetic effects. These molecules have proven beneficial roles in prevention and management of nondiabetic CVD and renal disease as well. There are various molecular mechanisms for the organ protective effects of SGLT-2i which are still being elucidated. Proper understanding of the role of SGLT-2i in prevention and management of CVD is important not only for the cardiologists but also for other specialists caring for various illnesses which can directly or indirectly impact care of heart diseases. This clinical review compiles the current evidence on the rational use of SGLT-2i in clinical practice.

Keywords: SGLT2 inhibitors; SGLT2i; Cardiovascular disease; Heart failure; Atherosclerotic cardiovascular disease; Diabetic kidney disease

Core Tip: The new antidiabetic medication class sodium glucose cotransporter-2 inhibitors (SGLT-2i) are found to have remarkable cardiovascular (CV) benefits proven by multiple randomised controlled trials and real-world observational studies. They are also useful in prevention of CV disease (CVD) in patients with diabetes mellitus. The CV benefits of SGLT-2i are not just because of antidiabetic effects. The preventive and management effects of SGLT2i molecules in diabetic and nondiabetic renal disease also translate into CV benefits. This clinical update review compiles the up-to-date evidence on the molecular mechanisms of SGLT-2i in prevention and management of CVD for empowering clinicians to rationalise the use of these molecules in day-to-day medical practice.