The role of SGLT2 inhibitors in chronic heart failure treatment

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a new group of medications for heart failure (HF) patient treatment, regardless of diabetes being present as comorbidity. Nevertheless, the mechanisms for positive influence of SGLT2 inhibitors on HF patients are not perfectly clear. The potential mechanisms include glycosuria, diuresis, anti-hypertensive effect, weight reduction, increase in the mass of red blood cells and hematocrit, but neither of these mechanisms does fully explain the proven positive clinical results in HF patients treated with SGLT2 inhibitors. There are recent discussions of new mechanisms of SGLT2 inhibitors as improvements in myocardial energetics and ion homeostasis, improved autophagy, improved balance in adipokine secretion, and lowered cardiovascular oxidative stress and inflammation. Despite the mounting scientific data, more studies are still necessary in order to identify the mechanisms of SGLT2 inhibitors in HF patients. Nevertheless, the available evidence and clinical trials have led to the inclusion of these medications in the European Guidelines for the diagnosis and treatment of acute and chronic HF, for the treatment of HF patients with reduced ejection fraction (EF), and possibly in the future for HF patients with preserved EF.