SGLT2 Inhibitors in patients with cancers

Abstract Background Cardiovascular disease (CVD) and cancer represent significant global health challenges. An overlap between oncology and cardiology is compounded by cancer therapies which are known to have cardiotoxic effects. Sodium-glucose cotransporter 2 inhibitors (SGLT2i), initially developed for treating diabetes, have shown promising cardiovascular benefits in non-cancer populations, particularly in preventing heart failure (HF) and reducing HF-related hospitalization and mortality in large randomized controlled trials across the spectrum of left ventricular ejection fraction (LVEF). However, their potential cardioprotective role in cancer patients remains unclear. Purpose This systematic review and meta-analysis evaluated cardiovascular outcomes in cancer patients undergoing chemotherapy with concomitant use of SGLT2i compared to those not using SGLT2i. Subgroup analyses were performed to explore patients without baseline HF and patients treated exclusively with anthracyclines. Results A systematic review identified eleven observational studies (n=104,327 patients). Based on the National Institutes of Health Quality Assessment Tool (NIH-QAT) checklist, all included studies presented a low risk of bias. Meta-analysis indicated that the use of SGLT2i was associated with a significant reduction in all-cause mortality (53%, 95% CI 0.33-0.67, P0.0001) and risk of HF hospitalization (56%, 95% CI 0.27-0.72, P=0.001). Conclusions SGLT2i use may be associated with improved cardiovascular outcomes in actively treated cancer patients who also have diabetes. Our study highlights the need for further investigation through prospective randomized clinical trials to confirm the efficacy and safety of SGLT2i in attenuating cardiotoxicity and supporting cardiovascular health in oncology settings.