Serendipity of sodium-glucose co-transporter 2 inhibitors: A new paradigm in the management of heart failure with reduced ejection fraction

Type 2 sodium-glucose co-transporter inhibitors (SGLT2i) are a new drug class with extremely relevant benefits in the prevention and treatment of heart failure (HF). In type 2 diabetic patients with both high cardiovascular risk and known cardiovascular disease, SGLT2i proved effective in reducing the risk of HF hospitalizations as well as the progression of renal disease. New evidence in patients with chronic HF and reduced ejection fraction (HFrEF) has also demonstrated their prognostic beneficial effects both in patients with and without type 2 diabetes mellitus. Based on these data, the use of this class of drugs in daily clinical practice is of primary importance to prevent HF hospitalization in diabetic patients and to improve the prognosis of HFrEF regardless of the presence of diabetes. In these patients, SGLT2i act synergistically with drugs capable of modulating the neurohormonal systems, thus allowing a further prognostic benefit.