More Evidence for SGLT2 Inhibitors in Heart Failure

In 2015, the EMPA-REG OUTCOME trial demonstrated that the sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin significantly reduced major adverse cardiovascular events, cardiovascular death, all-cause death, progression of renal disease, and hospitalization for heart failure in patients with type 2 diabetes and high cardiovascular risk. Subsequent trials of other SGLT2 inhibitors consistently confirmed the benefit in reducing hospitalization for heart failure, leading to the question of whether this benefit was independent of diabetes.

This question was affirmatively answered in 2019 with the DAPA-HF trial, which showed dapagliflozin reduced the risk of worsening heart failure or cardiovascular death in patients with heart failure and a reduced ejection fraction, irrespective of their diabetes status. Further supporting this, the EMPEROR-Reduced trial (published in the same issue) similarly found that empagliflozin reduced the composite of cardiovascular death or hospitalization for heart failure in patients with heart failure and a reduced ejection fraction, regardless of diabetes. These findings solidify the role of SGLT2 inhibitors as a fundamental treatment for heart failure with a reduced ejection fraction, and suggest potential benefits for patients with preserved ejection fraction as well.