The expanding role of SGLT2 inhibitors in cardiovascular and renal protection

Abstract

Sodium-glucose co-transporter 2 (SGLT2) inhibitors, initially designed for glycemic control in type 2 diabetes mellitus, have emerged as transformative agents in cardiovascular and renal protection. Landmark trials such as DAPA-HF, EMPA-REG OUTCOME, and DAPA-CKD have demonstrated their ability to reduce hospitalizations, cardiovascular mortality, and progression to end-stage renal disease, even in non-diabetic patients. These benefits are attributed to mechanisms beyond glucose lowering, including reducing intraglomerular pressure, promoting natriuresis, enhancing mitochondrial efficiency, and mitigating oxidative stress. SGLT2 inhibitors now offer disease-modifying effects across conditions such as heart failure and chronic kidney disease, reshaping therapeutic strategies. Despite their demonstrated efficacy, clinical adoption remains suboptimal, particularly in non-diabetic populations. Expanding awareness of their broad indications and unique mechanisms is crucial to leveraging their full potential. As ongoing research continues to uncover additional benefits, SGLT2 inhibitors are poised to play an increasingly vital role in improving cardiovascular and renal outcomes across diverse patient populations.