Key result
SGLT2 inhibitors blunt troponin rise in T2D but show no benefit in HFrEF.
Why the study?
There is a lack of clinical data regarding SGLT2 inhibitors' effects on myocardial injury assessed by cardiac injury biomarkers.
Does SGLT2 inhibitors reduce cardiac injury biomarkers (particularly hs-cTn) in individuals with diabetes or cardiovascular diseases?
Systematic Review (n=10,440)
Does SGLT2 inhibitors reduce cardiac injury biomarkers (particularly hs-cTn) in individuals with diabetes or cardiovascular diseases?
SGLT2 inhibitors may reduce myocardial injury by attenuating the rise in high-sensitivity troponin in patients with T2DM, but they do not appear to significantly alter troponin levels in patients with established HFrEF or acute myocardial infarction.
May attenuate myocardial injury in T2DM; extends SGLT2i effects to biomarkers but leaves HFrEF benefit unresolved.
There is a lack of clinical data regarding sodium-glucose cotransporter-2 (SGLT2) inhibitors’ effects on myocardial injury, a common clinical condition that deteriorates patient prognosis. Hence, this systematic review aims to investigate the effects of SGLT2 inhibitors on myocardial injury, using the cardiac injury biomarkers, particularly high‐sensitivity cardiac troponin (hs-cTn). We performed a literature review on Embase, MEDLINE (PubMed), and the Cochrane Library, up to May 27, 2025. All potentially relevant randomized clinical trials (RCTs) assessing the effects of SGLT2 inhibitors on myocardial injury in individuals with diabetes or cardiovascular diseases were identified. The outcome measures were the most relevant cardiac injury biomarkers, including hs-cTnT and hs-cTnI, creatine kinase (CK)-MB, heart-type fatty acid-binding protein (H-FABP), myoglobin, lactate dehydrogenase (LDH), ischemia-modified albumin, and glycogen phosphorylase BB. In total, 1770 articles were identified through the literature search. After eliminating duplicates and screening articles, 10 studies involving 10440 participants were included. Of them, 6 studies evaluated hs-cTnT and 4 studies evaluated hs-cTnI. Among individuals with type 2 diabetes mellitus (T2DM), four of six trials showed significant attenuation in hs-cTn rise with SGLT2 inhibitors. In contrast, studies on HFrEF populations reported no significant change in hs-cTn levels. One study, including patients with acute myocardial infarction, also did not demonstrate a significant effect on hs-cTnI. The outcomes of this systematic review may suggest the potential effects of SGLT2 inhibitors in reducing myocardial injury by lowering hs-cTn levels in T2DM individuals. However, more studies are recommended to provide robust evidence.
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Khani et al. (2025) conducted a systematic review in Type 2 diabetes mellitus or cardiovascular diseases (n=10,440). SGLT2 inhibitors vs. Placebo or conventional treatment was evaluated on Levels of cardiac injury biomarkers, particularly high-sensitivity cardiac troponin (hs-cTn). SGLT2 inhibitors significantly attenuated the rise in high-sensitivity cardiac troponin in four of six trials involving patients with type 2 diabetes mellitus, but showed no significant effect in heart failure with reduced ejection fraction.
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