SGLT2 inhibitors in heart failure and type 2 diabetes: from efficacy in trials towards effectiveness in the real world.

First data from a RCT with a sodium-dependent glucose co-transporter 2 (SGLT2) inhibitor on HF-related endpoint in patients with type 2 diabetes were published in 2015 when in the EMAP-REG Outcome trial empagliflozin showed significant reduction in the combined primary endpoint (3-MACE), and—somewhat unexpected—a highly significant early reduction of HF hospitalization (HHF) compared with placebo. 4 This finding has been principally confirmed with other SGLT2 inhibitors in the diabetes cardiovascular outcome trials (CVOTs) DECLARE, 5 CANVAS, 6 and VERTIS-CV, 7 and analysed in a meta-analysis. 8 Based on these early data, dedicated trials in patients with HF with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF) with and without diabetes have been performed (EMPEROR-REDUCED, DAPA-HF, EMPEROR-PRESERVED, DELIVER, and SOLOIST-HF).

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