IMR Press / RCM / Volume 22 / Issue 4 / DOI: 10.31083/j.rcm2204133
Open Access Review
SGLT2 inhibitors: a new pillar of the heart failure regimen
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1 Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX 75246, USA
2 Advanced Heart Failure, Mechanical Circulatory Support, and Transplantation Section, Baylor University Medical Center, Dallas, TX 75246, USA

Academic Editor: Julio Núñez Villota

Rev. Cardiovasc. Med. 2021, 22(4), 1253–1269;
Submitted: 1 September 2021 | Revised: 28 September 2021 | Accepted: 11 October 2021 | Published: 22 December 2021
(This article belongs to the Special Issue Interventions for the failing left ventricle)
Copyright: © 2021 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license (

Initially intended as an adjunct treatment for type 2 diabetes mellitus (T2DM), SGLT2-inhibitors (SGLT2i) have transformed into an unexpected pillar of the heart failure (HF) regimen. The past several years have witnessed a meteoric rise of this drug class, starting with the serendipitous results of trials assessing the safety of the glucose-lowering therapy in a broad range of cardiovascular patients and culminating with the demonstration of a reduction in hospitalizations for heart failure and cardiovascular mortality in dedicated heart failure populations. The heart failure benefits of SGLT2i are independent of a patient’s glycemic status, but the salient mechanisms of cardioprotection remain a subject of robust debate and ongoing research. Cardiologists as well as physicians of other disciplines should become familiar with the main indications, benefits, and clinical consideration of implementation. In this review, we will discuss the advance of SGLT2i in heart failure, ranging from the results of large randomized clinical trials to potential mechanisms of action.

Heart failure
Fig. 1.
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