Key result
SGLT2 inhibitors are not associated with skeletal muscle loss in cardiac rehabilitation patients.
Why the study?
SGLT2 inhibitors cause urinary glucose and calorie loss, raising a potential risk of skeletal muscle loss and sarcopenia, but evidence regarding these risks in patients with cardiovascular disease participating in outpatient cardiac rehabilitation was lacking.
Do SGLT2 inhibitors affect changes in skeletal muscle index and exercise tolerance in patients participating in outpatient cardiac rehabilitation?
Cohort (n=40)
Do SGLT2 inhibitors affect changes in skeletal muscle index and exercise tolerance in patients participating in outpatient cardiac rehabilitation?
SGLT2 inhibitor use does not lead to skeletal muscle loss or impair improvements in exercise tolerance among cardiovascular disease patients undergoing outpatient cardiac rehabilitation.
Background Sodium / Glucose co-transporter 2 (SGLT2) inhibitors are widely used in patients with cardiovascular disease. Due to glucose and calorie loss into the urine caused by SGLT2 inhibitors, there is a potential risk of skeletal muscle loss and sarcopenia in patients taking this medicine. However, there is no evidence of those risks in patients with cardiovascular disease. Purpose This study aimed to investigate the effect of SGLT2 inhibitors on temporal changes in skeletal muscle index (SMI) measured by bioelectrical impedance analysis in patients participating in outpatient cardiac rehabilitation programs. Methods Forty-six patients participating in outpatient cardiac rehabilitation programs were enrolled. Patients implanted cardiac devices such as cardiac pacemakers or implantable cardioverter-defibrillator were excluded (n=6). Patients were divided into two groups: those taking SGLT2i [SGLT2i (+); n=15] and those not [SGLT2i (-); n=25]. SMI was measured at discharge and reassessed approximately four months later. Cardiopulmonary exercise testing was also performed at the same time. The changes of SMI and exercise tolerance between two points were compared. Results In the total population, both SMI and peak VO2 showed significant improvement over the follow-up period.Both groups showed significant improvement in peak VO2 (SGLT2i (+) p=0.01, SGLT2i (-) p=0.02), but not in SMI (SGLT2i (+) p=0.14, SGLT2i (-) p=0.11). The changes of SMI (ΔSMI; SGLT2i (+) 0.30±0.90 vs. SGLT2i (-) 0.25±0.62 kg/m2, p=0.84), peak VO2 (Δpeak VO2; 1.13±2.29 vs. 1.95±2.58 ml/min/kg, p=0.30, respectively) showed no significant differences between two groups. Conclusion SGLT2 inhibitors did not cause skeletal muscle loss or sarcopenia in patients participating in outpatient cardiac rehabilitation.ChartResults
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Kanazawa et al. (2026) conducted a cohort in Cardiovascular disease in outpatient cardiac rehabilitation (n=40). SGLT2 inhibitors vs. No SGLT2 inhibitors was evaluated on Change in skeletal muscle index (ΔSMI) (p=0.84). SGLT2 inhibitors did not cause skeletal muscle loss in cardiac rehabilitation patients compared with non-use (ΔSMI 0.30±0.90 vs 0.25±0.62 kg/m2, p=0.84).
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