SCIENTIFIC JOURNAL of the Hungarian Society of Cardiology

Efficacy of SLGT-2 inhibitors in patients with heart failure or at high risk for cardiovascular events – a systematic review

█ Review

DOI: 10.26430/CHUNGARICA.2022.52.2.142

Merkel Eperke Dóra, Masszi Richárd, Behon Anett, Kosztin Annamária*, Merkely Béla*
Semmelweis Egyetem, Városmajori Szív- és Érgyógyászati Klinika, Budapest
Levelezési cím:
Dr. Merkely Béla PhD, DSc, Semmelweis Egyetem, Városmajori Szív- és Érgyógyászati Klinika
1122 Budapest, Varosmajor 68. E-mail:


Background: Heart failure patients present a highly frail patient population disposing of great cardiovascular mortality. A shift can be observed in the treatment of heart failure patients owed to sodium-glucose co-transporter 2 inhibitors (SGLT-2), due to their ability to successfully decrease the risk of cardiovascular and heart failure events.
Methods: We have screened and collected into our systematic review those multicentric, randomized controlled trials (RCT) and meta-analyses that studied SGLT-2 inhibitors regarding all-cause mortality and heart failure hospitalizations as endpoints.
Results: Based on our search, we included 12 RCTs and 3 meta-analyses. Altogether 5 RCTs analyzed diabetic patients with high cardiovascular risk, 3 trials were conducted with chronic and 3 with acute heart failure, with only one with diabetes as a criterion. The studied drugs (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin,sotagliflozin) decreased heart failure hospitalizations by 27-33% when compared to placebo. In respect of all-cause mortality, dapagliflozin significantly lowered the risk in heart failure patients with reduced ejection fraction regardless of diabetes (HR=0.83; 95% CI: 0.71–0.97), furthermore, empagliflozin showed similar results in high risk, diabetic patients (HR=0.68; 95% CI: 0.57–0.82). As for side effects, SGLT-2 inhibitors can be used safely in heart failure patients. Renal endpoints also show favourable outcome, since SGLT-2 inhibitors slow the progression of renal function deterioration compared to placebo.
Conclusion: Prior RCTs concordantly demonstrate the efficacy of SGLT-2 inhibitors in the reduction of heart failure events, especially in high-risk patients. Besides them being safe in heart failure patients, its effectiveness was also observed in regards to all-cause mortality and the preservation of renal function.


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