SGLT2 inhibitors were originally developed for diabetes, but they’ve become game-changers in heart failure treatment, helping patients feel better, stay out of the hospital, and even live longer – whether they have diabetes or not!
Who Should Be on an SGLT2 Inhibitor? (Indications)
SGLT2 inhibitors like Dapagliflozin and Empagliflozin are recommended for:
✔ Heart Failure with Reduced Ejection Fraction (HFrEF) (EF ≤40%)
- First-line treatment alongside beta-blockers, ACE inhibitors (or ARNI), and MRAs.
- Proven to reduce hospitalizations and improve survival.
✔ Heart Failure with Preserved or Mildly Reduced Ejection Fraction (HFpEF & HFmrEF) (EF >40%)
- Help relieve symptoms and keep patients out of the hospital.
✔ Chronic Kidney Disease (CKD)
- Slows kidney decline and protects against heart failure complications.
✔ Type 2 Diabetes with High Cardiovascular Risk
- Lowers the risk of developing heart failure and reduces hospital admissions.
How Do SGLT2 Inhibitors Help in Heart Failure? (Mechanism of Action)
These medications don’t just lower blood sugar – they help the heart work better by:
✔ Getting Rid of Extra Fluid (Natriuresis & Diuresis) – Helps with swelling and breathlessness.
✔ Lowering Blood Pressure & Afterload – Reduces strain on the heart.
✔ Boosting Energy Efficiency – Helps the heart burn ketones instead of glucose, which provides more energy with less oxygen.
✔ Reducing Heart Stiffness & Fibrosis – Keeps the heart more flexible and functional.
✔ Protecting the Kidneys – Helps prevent further kidney damage, which is common in heart failure.
✔ Calming Down the Stress Hormones – Reduces harmful overactivation of the sympathetic nervous system.
When Should SGLT2 Inhibitors Be Avoided? (Contraindications)
While generally safe and well-tolerated, these medications aren’t for everyone.
🚫 Do NOT use if:
- You have Type 1 Diabetes (can trigger dangerous ketoacidosis).
- You’ve had Diabetic Ketoacidosis (DKA) before.
- Your kidneys aren’t working well (eGFR <15 mL/min/1.73m² – some say ≥20 is OK).
- You have a severe urinary or genital infection (risk of rare but serious infections).
⚠ Use with caution if:
- You get frequent UTIs or yeast infections.
- You have low blood pressure or get dizzy easily.
- You’re elderly or prone to falls.
- You take strong diuretics – you might need a dose adjustment.
- You have severe liver disease (not enough research yet).
- You’re pregnant, breastfeeding, or about to have surgery – it’s best to stop temporarily.
Why Does the Heart Prefer Ketones Over Glucose?
Your heart needs a LOT of energy to keep pumping. In heart failure, it struggles to get enough fuel. SGLT2 inhibitors help by switching the heart’s energy source from glucose to ketones, which:
✔ Produce more ATP per oxygen unit, making them a super-efficient energy source.
✔ Reduce oxidative stress, helping the heart work better.
✔ Improve heart function, especially in failing hearts.
This shift explains why SGLT2 inhibitors help heart failure patients – even those without diabetes!
Bottom Line
SGLT2 inhibitors are a must-have for most people with heart failure – they help you feel better, reduce hospital visits, and even help you live longer. If you’re a doctor, they should be on your go-to treatment list for patients with heart failure.
