What is the clinical evidence from this study?

Study design: Observational. Population: Heart failure with reduced ejection fraction (HFrEF) (n=80). Intervention: SGLT2 inhibitors vs. Baseline. Primary outcome: Mean platelet volume (MPV) (p=<0.001).

June 24, 2026Open Access

Effect of SGLT2 inhibitors on mean platelet volume in heart failure with reduced ejection fraction: a real-world analysis independent of diuretic therapy

Q: What are the key findings of this study?

SGLT2 inhibitor therapy significantly reduced mean platelet volume from 11.4 fL to 9.1 fL over 6 months in patients with heart failure with reduced ejection fraction.

Q: What question did this study set out to answer?

This study aims to explore the effects of SGLT2 inhibitors on mean platelet volume in heart failure with reduced ejection fraction patients.

HOHüseyin OrtaTekirdağ Namık Kemal University CACihan AydınBozok Universitesi ADAykut DemirkıranTekirdağ Namık Kemal University

Key Result

SGLT2 inhibitor therapy significantly reduced mean platelet volume from 11.4 fL to 9.1 fL over 6 months in patients with heart failure with reduced ejection fraction.

Key Points

This study aims to explore the effects of SGLT2 inhibitors on mean platelet volume in heart failure with reduced ejection fraction patients.
Retrospective analysis of 80 HFrEF patients under guideline-directed medical therapy and SGLT2 inhibitors.
Baseline and 6-month follow-up data collected on hematological parameters, including MPV and platelet counts.
Standardized protocols used for analyzing MPV and platelet counts with exclusions for specific comorbidities.
After 6 months of SGLT2 inhibitor therapy, mean platelet volume decreased significantly (p < 0.05).
Platelet counts increased significantly (p < 0.05) following the same treatment.
No significant correlation was found between changes in MPV and platelet counts.

Study Design

Type

Observational (n=80)

Multicenter

Structured PICO

Do SGLT2 inhibitors reduce mean platelet volume in patients with HFrEF?

Population

80 patients with heart failure with reduced ejection fraction on guideline-directed medical therapy who were subsequently started on SGLT2 inhibitors, followed for 6 months.

Exposure

SGLT2 inhibitors added to guideline-directed medical therapy for 6 months

Comparator

Baseline values prior to SGLT2 inhibitor initiation (pre-post comparison)

Outcome

Change in mean platelet volume (MPV) at 6 monthssurrogate

SGLT2 inhibitors significantly reduce mean platelet volume in HFrEF patients, suggesting a potential hematological mechanism for their cardiovascular benefits.

Main Result

Absolute Event Rate: 9.1% vs 11.4%

p-value: p=<0.001

Limitations

Retrospective and non-randomized observational design limits the ability to establish causality.
Most patients were on aspirin or clopidogrel, which can affect MPV.
Environmental factors such as climate and altitude differences were not investigated.
MPV was used as the sole indicator of platelet function.
Potential confounders like smoking status, body weight changes, and blood pressure variations were not consistently available.
Small sample size precluded multivariate analysis.

Abstract

Sodium-glucose co-transporter 2 (SGLT2) inhibitors have emerged as cornerstone therapies for heart failure with reduced ejection fraction (HFrEF), owing to their cardioprotective and hematologic effects. While their impact on hemoglobin and hematocrit levels is increasingly recognized, the influence of SGLT2 inhibitors on mean platelet volume (MPV), a surrogate marker of platelet activation and cardiovascular risk, remains underexplored in HFrEF patients. While SGLT2 inhibitors' effects on MPV have been studied in DM, this is the first study examining MPV changes specifically in HFrEF patients with adjustment for diuretic therapy. This retrospective study included 80 HFrEF patients receiving guideline-directed medical therapy to which SGLT2 inhibitors were subsequently added. Baseline and 6-month follow-up data on hematological and biochemical parameters were collected. Exclusion criteria included active infection, malignancy, advanced renal failure, hematologic disorders, and recent transfusions. MPV and platelet counts were analyzed using standardized protocols and equipment. Following 6 months of SGLT2 inhibitor therapy, MPV values decreased significantly (p < 0.05), while platelet counts increased significantly (p < 0.05). Although hemoglobin and hematocrit levels showed upward trends, these changes were not statistically significant. No significant correlation was observed between ΔMPV and ΔPLT. Other biochemical markers remained stable throughout the study period. SGLT2 inhibitor therapy was associated with a significant reduction in MPV and an increase in platelet count among patients with HFrEF. These hematological changes may represent an additional mechanism by which SGLT2 inhibitors exert cardiovascular benefit. However, prospective, randomized trials are needed to validate these findings and explore the clinical significance of MPV modulation in heart failure management.

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