Cardioprotective effects of SGLT2 inhibitors on cardiac dysfunction in cancer patients receiving anthracycline chemotherapy: a systematic review

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Cancer-therapy related cardiac dysfunction (CTRCD) in patients receiving anthracyclines (n=11977). Intervention: SGLT2 inhibitors vs. No SGLT2 inhibitor treatment. Primary outcome: Heart failure hospitalisations and overall mortality.

D. Junior; G. B. Bramantara; I Gusti Ngurah Ariestha Satya Diksha; R. C. Suteja; I. N. Wiryawan

doi:10.3897/bgcardio.32.e175390

April 30, 2026Bulgarian CardiologyOpen Access

Cardioprotective effects of SGLT2 inhibitors on cardiac dysfunction in cancer patients receiving anthracycline chemotherapy: a systematic review

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Key result

SGLT2 inhibitors reduce HF hospitalizations and overall mortality in T2D cancer patients receiving anthracyclines.

n=11,977

Why the study?

Anthracyclines are linked to cancer-therapy related cardiac dysfunction, and SGLT2 inhibitors are potential cardioprotective agents to reduce this toxicity.

Does SGLT2 inhibitor treatment reduce heart failure hospitalisations and overall mortality in cancer patients receiving anthracycline chemotherapy?

Key Points

To report the cardioprotective effects of SGLT2 inhibitors on cancer therapy-related cardiac dysfunction in cancer patients receiving anthracycline chemotherapy.
Conducted a systematic review following PRISMA guidelines by searching PubMed, Scopus, and DOAJ on July 24th, 2024.
Identified studies comparing heart failure hospitalisations and overall mortality between anthracycline-treated cancer patients receiving SGLT2 inhibitors and those not receiving them.
Three cohort studies met inclusion criteria and showed that patients receiving SGLT2 inhibitors experienced fewer hospitalisations for heart failure and lower overall mortality than non-recipients.
Cardioprotective benefits are achieved primarily through the attenuation of anthracycline-induced oxidative stress, mitochondrial dysfunction, apoptosis, and inflammation.
Evidence is currently restricted to cancer patients with preexisting type 2 diabetes mellitus, indicating a need for broader trials in the general population.

Study Design

Type

Systematic Review (n=11,977)

Structured PICO

Does SGLT2 inhibitor treatment reduce heart failure hospitalisations and overall mortality in cancer patients receiving anthracycline chemotherapy?

P

Population

Cancer patients with a history of anthracycline therapy and preexisting type 2 diabetes mellitus (T2DM) (3 retrospective cohort studies pooling 11,977 patients).

I

Intervention

SGLT2 inhibitors

C

Comparator

Non-SGLT2 inhibitor treatment (patients with T2DM not receiving SGLT2 inhibitors, and in one study, a non-DM group without SGLT2 inhibitors)

O

Outcome

Hospitalisation with heart failure (HF) as the primary cause, and overall mortalityhard clinical

SGLT2 inhibitors may offer cardioprotective effects against anthracycline-induced cardiotoxicity in cancer patients with type 2 diabetes, reducing heart failure hospitalizations and overall mortality.

Limitations

Available studies are limited to cancer patients with preexisting type 2 diabetes mellitus (T2DM).
One included study had a serious risk of bias due to potential confounding variables that had not been accounted for.
Zero heart failure hospitalisations in the intervention group of one study hindered the calculation of the effect size.
One included study had a serious risk of bias due to unaccounted potential confounding variables.
One study had zero HF hospitalizations in the SGLT2 inhibitor group, hindering the calculation of the effect size.

Implication

SGLT2 inhibitors open a new preventive axis for anthracycline CTRCD; extends early evidence but leaves open routine adoption pending RCTs.

Abstract

Background: Anthracyclines have been associated with cancer-therapy related cardiac dysfunction (CTRCD). Sodium-glucose co-transporter 2 (SGLT2) inhibitors are potential cardioprotective agents that could reduce cardiotoxicity in cancer patients receiving anthracyclines. This review aims to report the cardioprotective effects of SGLT2 inhibitors on CTRCD in cancer patients receiving anthracycline chemotherapy. Methods: This study is a systematic review written according to PRISMA guidelines. We searched PubMed, Scopus, and DOAJ on July 24th, 2024, for studies that compared heart failure (HF) hospitalisations and overall mortality between cancer patients with a history of anthracycline therapy who received SGLT2 inhibitor treatment and those without. Results: Three studies included in our review found that subjects in the SGLT2 inhibitor treatment group had fewer hospitalisations due to HF and lower overall mortality than those in the non-SGLT2 inhibitor treatment group. The cardioprotective effects of SGLT2 inhibitors are achievable mainly through their ability to attenuate oxidative stress, mitochondrial dysfunction, apoptosis, and inﬂ ammation induced by anthracycline toxicity. Conclusions: Cohort studies have shown that SGLT2 inhibitors exhibit cardioprotective effects in cancer patients receiving anthracycline chemotherapy through their extensive pharmacodynamics. However, available studies are limited to cancer patients with preexisting type 2 diabetes mellitus (T2DM). Hence, future trials tailored to the general population are highly needed to yield results with greater validity.

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Cite This Study

Junior et al. (2026) conducted a systematic review in Cancer-therapy related cardiac dysfunction (CTRCD) in patients receiving anthracyclines (n=11,977). SGLT2 inhibitors vs. No SGLT2 inhibitor treatment was evaluated on Heart failure hospitalisations and overall mortality. SGLT2 inhibitors reduced heart failure hospitalizations and overall mortality in cancer patients with type 2 diabetes receiving anthracycline chemotherapy.

synapsesocial.com/papers/69fd7d4abfa21ec5bbf05cd3 https://doi.org/10.3897/bgcardio.32.e175390