Background: The impact of overt diabetes and poor glycemic control on the risk of
cardiovascular disease is well established. Among patients with type 2 diabetes, several studies
demonstrated a significant increase in coronary artery disease-related death and cardiovascular events
associated with HbA1c levels of greater than 7% compared with lower levels. Sodium-glucose
cotransporter 2 (SGLT-2) inhibitors are a novel class of anti-diabetic drugs that lower blood glucose
levels through the suppression of renal glucose reabsorption thereby promoting renal glucose excretion.
Objectives: To summarize data on the potential mechanisms of SGLT-2 inhibition that could exert
cardiovascular benefits in patients with diabetes mellitus.
Method: We conducted an in-depth literature search of SGLT-2 inhibitors and potential
cardiovascular benefits and mechanisms that mediate those effects.
Results: In diabetes, expression of the SGLT-2 genes is up-regulated and renal threshold increased,
resulting in increased glucose reabsorption from glomerular filtrate, reducing urinary glucose
excretion and worsening hyperglycemia. SGLT-2 inhibition should offer potential cardiovascular
protection in diabetic patients via attenuating hyperglycemia, blood pressure, body weight, hyperuricemia,
and diabetic nephropathy.
Conclusion: The initial data of SGLT-2 inhibitors suggest beneficial effects on cardiovascular risk
among patients with diabetes mellitus. Several mechanisms are hypothesized to mediate the
abovementioned benefits. Future randomized, controlled studies are needed in order to unveil the
contribution of each mechanism to these outcomes.