Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr;12(2):1271-1282.
doi: 10.1002/ehf2.15136. Epub 2024 Nov 20.

Effects of sodium-glucose co-transporter inhibitors on individual clinical endpoints and quality of life

Jia Liao  1   2 , Yang Chen  1 , Zhiyu Ling  1 , Helmut Pürerfellner  3 , Martin Martinek  3 , Michael Derndorfer  3 , Johannes Niel  3 , Ramin Ebrahimi  4 , Matthias Heukäufer  4 , Sarah Janschel  4 , Davide Di Vece  4   5 , Klaus Empen  4 , Astrid Hummel  4 , Bishwas Chamling  4 , Piotr Futyma  6 , Fahim Ebrahimi  7   8   9 , Márcio G Kiuchi  10 , Shaowen Liu  11 , Yuehui Yin  1 , Alexandra Schratter  12 , Willem-Jan Acou  13 , Philipp Sommer  14 , Boris Schmidt  15 , Julian K R Chun  15 , Christian Meyer  16   17   18 , Marcus Dörr  4   19 , Christian Templin  4 , Shaojie Chen  4
Affiliations

Effects of sodium-glucose co-transporter inhibitors on individual clinical endpoints and quality of life

Jia Liao et al. ESC Heart Fail. 2025 Apr.

Abstract

Aims: Sodium-glucose co-transporter inhibitors (SGLTis) have cardiovascular protective effects. We aimed to assess the effects of SGLTis on individual hard clinical endpoints and quality of life (QoL) in patients with cardiovascular risk factors.

Methods and results: Data was searched in PubMed, Embase, Cochrane Library and clinicaltrials.gov databases up to February 2024. Randomized controlled trials (RCTs) comparing SGLTis with placebo were included. The primary outcomes were individual hard clinical endpoints (Subset A) and QoL (Subset B). For Subset A, 13 RCTs including 90 413 patients were enrolled (age 66 ± 10.1 years, 35.7% female, follow-up 2.4 ± 0.3 years); as compared with placebo, SGLTis were associated with significantly lower risk of all-cause mortality [risk ratio (RR): 0.90, 95% confidence interval (CI): 0.86-0.94, P < 0.01], cardiovascular mortality (RR: 0.87, 95% CI: 0.82-0.92, P < 0.01), hospitalization for heart failure (HF) (RR: 0.72, 95% CI: 0.68-0.76, P < 0.01), HF events (RR: 0.72, 95% CI: 0.68-0.75, P < 0.01), hospitalization for any cause (RR: 0.91, 95% CI: 0.88-0.93, P < 0.01) and myocardial infarction (MI) (RR: 0.92, 95% CI: 0.85-0.99, P = 0.03). Notably, the favourable effect of SGLTis on all-cause mortality was more pronounced in younger (<65 years) patients (RR: 0.86, 95% CI: 0.81-0.92) and in studies with less female (RR: 0.84, 95% CI: 0.79-0.90). The favourable effect of SGLTis on MI was only observed in patients who received sotagliflozin (RR: 0.47, 95% CI: 0.31-0.73). For Subset B, nine RCTs including 2552 HF patients were enrolled (age 67.8 ± 12.4 years, 36.4% female, follow-up 3.4 ± 1.9 months); SGLTis were associated with significant improvement in QoL as compared with placebo.

Conclusions: In patients with a broad spectrum of cardiovascular risk factors, SGLTis substantially improve individual hard clinical outcomes and QoL.

Keywords: cardiovascular outcomes; heart failure (HF); myocardial infarction; quality of life; renal disease; sodium–glucose co‐transporter inhibitors (SGLTis); type 2 diabetes mellitus (T2DM).

PubMed Disclaimer

Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Subset A: pooled analyses of individual clinical endpoints. CI, confidence interval; CV, cardiovascular; HFE, heart failure event; HHF, hospitalization for heart failure; MI, myocardial infarction; REML, restricted maximum likelihood; SGLT2i, sodium–glucose co‐transporter 2 inhibitor.
Figure 2
Figure 2
Subgroup analyses based on significant variables. (A) Effect of sodium–glucose co‐transporter 2 inhibitor (SGLT2i) on all‐cause mortality: impact of age. (B) Effect of SGLT2i on all‐cause mortality: impact of gender. (C) Effect of different SGLT2is on myocardial infarction. CI, confidence interval; REML, restricted maximum likelihood.
Figure 3
Figure 3
Subset B: pooled analyses of improvement in quality of life. CI, confidence interval; KCCQ‐CSS, Kansas City Cardiomyopathy Questionnaire Clinical Summary Score; KCCQ‐OSS, Kansas City Cardiomyopathy Questionnaire Overall Summary Score; KCCQ‐TSS, Kansas City Cardiomyopathy Questionnaire Total Symptom Score; REML, restricted maximum likelihood; SGLT2i, sodium–glucose co‐transporter 2 inhibitor.
Figure 4
Figure 4
Effects of SGLTi on Individual Clinical Endpoints and Quality‐of‐Life: outcome from randomized data.
See this image and copyright information in PMC

References

    1. Vallon V, Thomson SC. Targeting renal glucose reabsorption to treat hyperglycaemia: the pleiotropic effects of SGLT2 inhibition. Diabetologia 2017;60:215‐225. doi:10.1007/s00125-016-4157-3 - DOI - PMC - PubMed
    1. Neal B, Perkovic V, Mahaffey KW, de Zeeuw D, Fulcher G, Erondu N, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med 2017;377:644‐657. doi:10.1056/NEJMoa1611925 - DOI - PubMed
    1. Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015;373:2117‐2128. doi:10.1056/NEJMoa1504720 - DOI - PubMed
    1. Wiviott SD, Raz I, Bonaca MP, Mosenzon O, Kato ET, Cahn A, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2019;380:347‐357. doi:10.1056/NEJMoa1812389 - DOI - PubMed
    1. McMurray J, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med 2019;381:1995‐2008. doi:10.1056/NEJMoa1911303 - DOI - PubMed

Substances