Sodium-glucose cotransporter-2 inhibitors in heart failure patients: an appraisal of recent cardiovascular outcome trials

Although initially introduced as a novel oral glucose-lowering agent class, cumulative evidence from randomized controlled trials (RCTs) have led sodium-glucose cotransporter-2 inhibitors (SGLT2i) to become a component of primary and secondary prevention from atherosclerotic cardiovascular disease in patients with type 2 diabetes mellitus (T2DM). Dapagliflozin, one of the agents of this class, was investigated in 2019 in patients with heart failure (HF) independent of being diagnosed with T2DM at baseline. Since then, many other studies are being undertaken in this class of drugs. Herein, we aimed to review the RCTs, their subgroup and post-hoc analyses that examined the effects of SGLT2i on cardiovascular outcomes (including HF-related outcomes) in patients diagnosed with HF that were published until June 2020. We also summarized the ongoing trials that aim to assess the impact of SGLT2i on cardiovascular outcomes in patients with HF and listed available guideline recommendations regarding the use of SGLT2i for cardiovascular disease management.