Abstract
Background:SGLT2 inhibitors were first introduced to help manage blood sugar in people with Type 2 Diabetes Mellitus (T2DM). Over time, researchers noticed something promising: these drugs also seemed to protect the heart, especially in patients who had both diabetes and heart failure (HF). They’ve been linked to fewer hospital visits for heart failure and lower rates of cardiovascular-related deaths, sparking growing interest in their potential as long-term therapy for different types of heart failure.
Aim:This review explores how SGLT2 inhibitors affect the heart over the long term in patients with T2DM and heart failure. It focuses on sustained benefits, how the drugs work at a biological level, and whether their effectiveness varies between those with heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF).
Methods:We conducted a narrative review of key clinical trials and observational studies published from 2019 to 2024. Studies included were major trials like DAPA-HF, EMPEROR-Reduced, DELIVER, and CANVAS. The main outcomes we looked at were hospitalizations due to heart failure, changes in heart function (measured by LVEF), death from cardiovascular causes, and how well the kidneys were protected over time.
Results:The evidence consistently shows that SGLT2 inhibitors improve heart health, particularly in patients with HFrEF. For those with HFpEF, the improvements were more moderate, but still meaningful. Researchers believe these benefits might be due to the drugs’ ability to reduce fluid overload, improve how the heart uses energy, and lower inflammation. That said, most of the data only cover up to 2–3 years, so the full long-term impact is still unclear.
Conclusion:SGLT2 inhibitors have become an important tool in managing heart failure in people with diabetes, especially those with reduced ejection fraction. They seem to offer lasting heart protection, and their use is expanding in chronic heart failure care. However, more long-term studies are needed to fully understand their role across all types of heart failure.
Keywords: SGLT2 inhibitors, Type 2 Diabetes Mellitus, heart failure, HFrEF, HFpEF, cardiovascular outcomes, long-term therapy.