Sodium glucose transporter 2 inhibitors for heart failure

Core Tip

Core Tip: Heart failure (HF) affects over 64 million people worldwide, with persistently poor outcomes despite advances in treatment. Sodium glucose transporter 2 inhibitors, originally developed for diabetes, have emerged as breakthrough HF therapies with cardiovascular benefits beyond glucose control, including reduced risk of hospitalization and mortality. Landmark trials (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure, Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Reduced Ejection Fraction, Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction, Dapagliflozin Evaluation to Improve the Lives of Patients with Preserved Ejection Fraction Heart Failure) have demonstrated efficacy across all HF types, regardless of diabetes status. Their benefits stem from improved cardiac energetics, enhanced mitochondrial function, reduced oxidative stress and inflammation, and favorable cardiac remodeling. This review examines current evidence, mechanistic pathways, and future prospects for sodium glucose transporter 2 inhibitor use in cardiovascular medicine.