BEYOND GLYCEMIA: SGLT2 INHIBITORS AS KEY PLAYERS IN CONTEMPORARY CARDIOLOGY

Abstract

Sodium-glucose cotransporter-2 inhibitors (SGLT2i), initially developed for diabetes management, have emerged as pivotal agents in contemporary cardiology. Evidence accumulated between 2020 and 2025 demonstrates benefits that extend beyond glycemic control, including consistent reductions in hospitalizations and mortality due to heart failure (HF), significant renal protection, and potential applications in acute coronary syndromes. An integrative literature review was conducted through PubMed/MEDLINE and the Virtual Health Library (BVS) from January 2020 to September 2025, including randomized clinical trials, meta-analyses, systematic reviews, and guidelines published in English and Portuguese with full-text availability. A total of 27 studies met the eligibility criteria. Large-scale trials demonstrated benefits in HF with both reduced and preserved ejection fraction, alongside robust evidence for renal protection. Recent studies in post-myocardial infarction patients expand future perspectives, although definitive results are still pending. Meta-analyses confirm the consistency of these findings, consolidating SGLT2i as disease-modifying therapies. In Brazil, where HF and chronic kidney disease account for high morbidity, mortality, and healthcare costs within the Unified Health System, the adoption of this pharmacological class has strategic importance, representing a true paradigm shift in clinical practice.