Cardioprotective effects of sodium-glucose transport protein 2 inhibitors in patients with breast cancer and concomitant type 2 diabetes mellitus undergoing chemotherapy

Background. Breast cancer continues to be the most frequently diagnosed malignancy among women globally, with millions of new cases identified each year. Despite significant advances in chemotherapy that have considerably enhanced survival rates, these improvements are often accompanied by adverse effects that may jeopardize long-term health. One of the most concerning complications is cardiotoxicity, which can range from subtle, asymptomatic alterations in cardiac function to overt, severe heart failure. This study purposed to evaluate the impact of sodium-glucose transport protein 2 inhibitors (SGLT2) inhibitors on diastolic function and endothelial health in breast cancer patients receiving chemotherapy. Materials and methods. A prospective, comparative, study was conducted at Ivano-Frankivsk Central City Clinical Hospital, Private Medical Center “Frankomed” and Lviv Private Medical Center “Rhythm” from January 2023 to May 2024. Fifty-five female patients with confirmed breast cancer and type 2 diabetes mellitus who were referred to cardiologist were enrolled and divided into three groups: group 1 (control, n = 27) received no SGLT2 inhibitors, group 2 (n = 15) received empagliflozin 10 mg daily, and group 3 (n = 13) received dapagliflozin. Echocardiographic assessments and flow-mediated dilation measurements were performed before chemotherapy initiation and after its completion. Results. The control group exhibited a significant deterioration in diastolic function, evidenced by a substantial decrease in the E/A ratio and an increase in the E/e’ ratio and isovolumetric relaxation time. In contrast, both empagliflozin and dapagliflozin groups maintained better diastolic profiles and endothelial function, as shown by less pronounced changes in echocardiographic parameters and flow-mediated dilation. Logistic regression confirmed that patients in the control group had significantly higher odds of developing abnormal follow-up indices compared with those receiving SGLT2 inhibitors. Additionally, a potential class effect was observed, with both agents offering cardioprotective benefits while exhibiting subtle differences in their impact. Conclusions. SGLT2 inhibitors appear to mitigate chemotherapy-induced cardiotoxicity by preserving diastolic function and endothelial health in patients with breast cancer concomitant with type 2 diabetes mellitus.