Efficacy of SGLT2 Inhibitors in Reducing Major Adverse Cardiovascular Events in Patients with Heart Failure with Preserved Ejection Fraction: A Literature Review

Abstract

Introduction: Heart failure with preserved ejection fraction (HFpEF) represents a relevant proportion of heart failure (HF) cases and is associated with high morbidity, mortality, and recurrent hospitalizations. Historically, available therapies have not consistently demonstrated a reduction in major cardiovascular events in this population. The class of sodium-glucose cotransporter 2 inhibitors (SGLT2i) — originally developed for Type 2 Diabetes — has emerged as a promising therapeutic alternative. Methodology: A literature review was performed using the PubMed database with the descriptors "sodium-glucose transporter 2 inhibitors," "heart failure with preserved ejection fraction," "major adverse cardiovascular events," "cardiovascular mortality," and "hospitalization." Two clinical trials of major relevance were selected. Discussion and Results: The current review consistently demonstrates that SGLT2i (empagliflozin and dapagliflozin) significantly reduce events of worsening HF and hospitalizations in patients with preserved or mildly reduced ejection fraction (EF > 40%), regardless of the presence of diabetes. While the evidence regarding the benefit on isolated cardiovascular death is less robust, the clinical impact on reducing hospitalizations and improving quality of life is evident. Conclusion: SGLT2i significantly reduce major cardiovascular events, strongly supporting the inclusion of this therapeutic class in the management of HFpEF, although further studies are still needed to evaluate isolated cardiovascular mortality and to stratify the benefit according to ejection fraction ranges.