Key result
SGLT2 inhibitors are linked to lower mortality and heart failure risk in rheumatic IMIDs.
Why the study?
Patients with rheumatic immune-mediated inflammatory diseases have increased cardiovascular risk, yet they were largely excluded from major SGLT2i trials, leaving it unclear whether SGLT2i benefits extend to these populations.
Do sodium-glucose co-transporter-2 inhibitors reduce all-cause mortality and major adverse cardiovascular events in adults with rheumatic immune-mediated inflammatory diseases?
Systematic Review (n=11,190)
Do sodium-glucose co-transporter-2 inhibitors reduce all-cause mortality and major adverse cardiovascular events in adults with rheumatic immune-mediated inflammatory diseases?
Predominantly observational evidence suggests SGLT2 inhibitors are associated with lower all-cause mortality and heart failure risk in patients with rheumatic diseases (mainly SLE and SSc), supporting the need for prospective controlled trials in this high-risk population.
Answers are grounded in this paper and cite their sources.
SGLT2i may lower mortality and HF risk in IMID patients with T2D/HF/CKD; leaves open need for RCTs to confirm CV benefit and IMID-specific safety.
INTRODUCTION: Rheumatic immune-mediated inflammatory diseases (IMIDs) are associated with increased cardiovascular morbidity and mortality. Sodium-glucose co-transporter-2 inhibitors (SGLT2i) improve cardiometabolic outcomes in high-risk populations, but IMID patients were largely excluded from major trials. It remains unclear to what extent these benefits extend to IMIDs. METHODS: Following PRISMA guidance, MEDLINE, Embase, PubMed, Cochrane Library and Web of Science Core Collection databases were searched (PROSPERO: CRD420261289071). Observational and interventional adult IMID studies reporting all cause-mortality, major adverse cardiovascular events (MACE; cardiovascular mortality, myocardial infarction, stroke, heart failure), safety or IMID disease activity with SGLT2i were included. RESULTS: Five studies including 11,190 IMID participants were identified: systemic sclerosis (SSc; 25.4%), systemic lupus erythematosus (SLE; 70.9%) and other IMIDs (3.9%). Across three studies reporting MACE, SGLT2i use was associated with lower all-cause mortality and heart failure risk, with no clear effect on myocardial infarction. Safety data were variably reported, with infections, particularly genitourinary infections, were most frequently reported. Evidence on hospitalisation, treatment discontinuation and IMID flare was limited and inconsistent. CONCLUSION: Predominantly observational data suggest a potential cardiovascular benefit of SGLT2 inhibitors in rheumatic IMIDs, but the available evidence is confined largely to SLE and SSc populations. Whilst SGLT2 inhibitors should be used in established indications of type 2 diabetes mellitus, heart failure and chronic kidney disease, prospective and controlled studies in IMID populations are needed to establish their cardiovascular benefit, clarify safety and evaluate for effect on disease activity.
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Gumber et al. (2026) conducted a systematic review in Rheumatic immune-mediated inflammatory diseases (predominantly systemic lupus erythematosus and systemic sclerosis) (n=11,190). Sodium-glucose co-transporter-2 inhibitors (SGLT2i) was evaluated on All-cause mortality and major adverse cardiovascular events (MACE: cardiovascular mortality, myocardial infarction, stroke, heart failure). SGLT2 inhibitor use in 11,190 adults with rheumatic IMIDs was associated with lower all-cause mortality and heart failure risk across three MACE-reporting studies.
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