The effect of SGLT2 inhibitors on cardiovascular events and renal function

Introduction: Sodium-glucose co-transporters-2inhibitors have emerged as a very promising antidiabetic drug class, with data from the two available cardiovascular trials of this class suggesting remarkable benefits in terms of cardiovascular events, total mortality and renal outcomes. Areas covered: Data point toward clinically meaningful benefits from SGLT-2inhibition on a variety of cardiovascular risk factors. Empagliflozin, and to a lesser extent canagliflozin, resulted in significant reductions of an abundance of cardiovascular mortality and morbidity endpoints. SGLT-2inhibitors were also found to reduce the incidence of heart failure events and ameliorate the progression of diabetic kidney disease. However, empagliflozin was associated with a trend for stroke risk increase, that could be partially attributed to the drug-induced hematrocrit increases, while canagliflozin was related with higher amputations risk. Expert commentary: The beneficial impact of SGLT-2inhibitors on cardiovascular risk factors seem to be manifested in significant morbidity and mortality benefits. The bright future of SGLT-2inhibitors in diabetes therapeutics is overshadowed by the higher amputations risk and the potential harms in terms of stroke incidence. Further analyses of the data and future studies could unveil patients subgroups that might be more prone to such events or put to rest the concerns for this otherwise promising class of drugs.