Sodium glucose cotransporter-2 inhibitors and heart disease: Current perspectives

Table 3 Role of sodium glucose cotransporter 2 inhibitors in the management a prevention of diabetes - position of different guidelines

Organize groups	Position of different guidelines
ADA, 2023	Among people with T2DM who have established ASCVD (a SGLT2i with demonstrated cardiovascular disease benefit is recommended as part of the comprehensive cardiovascular risk reduction and/or glucose - lowering regimens. (LOE: A)
	In people with T2DM who have established ASCVD, multiple atherosclerotic cardiovascular disease risk factors, or DKD, a SGLT2i with demonstrated cardiovascular benefit is recommended to reduce the risk of major adverse cardiovascular events and/or heart failure hospitalization. (LOE: A)
	In people with T2DM and established ASCVD or multiple risk factors for atherosclerotic cardiovascular disease, combined therapy with a SGLT2i and a GLP1-RA may be considered for additive reduction in the risk of adverse cardiovascular and kidney events. (LOE: A)
	In people with T2DM and established heart failure with either preserved or reduced ejection fraction, a SGLT2i with proven benefit in this patient population is recommended to reduce risk of worsening heart failure and cardiovascular death. (LOE: A)
	In people with T2DM and established heart failure with either preserved or reduced ejection fraction, a SGLT2i with proven benefit in this patient population is recommended to improve symptoms, physical limitations, and quality of life. (LOE: A)
AACE, 2023	SGLT2i should be started irrespective of glycemic target or other T2DM therapies in patients with T2DM and ASCVD or at high risk for ASCVD (albuminuria/proteinuria, hypertension and left ventricular hypertrophy, LV systolic or diastolic dysfunction, ankle-branchial index < 0.9)
ACC/AHA, 2022	In patients with symptomatic chronic HFrEF, SGLT2i are recommended to reduce hospitalisation for heart failure and CV mortality, irrespective of the presence of type 2 diabetes. (COR: 1, LOE: A)
	In patients with HFmrEF, SGLT2i can be beneficial in decreasing HF hospitalisation and CV mortality (COR: 1, LOE: A)
	In patients with HFpEF, SGLT2i can be beneficial in decreasing HF hospitalisation and CV mortality (COR: 1, LOE: A)
ESC, 2022	SGLT2i are recommended in all patients with HFrEF and T2DM to reduce the risk of HF hospitalization and CV death. (COR: 1, LOE: A)
	SGLT2i are recommended in patients with T2DM and LVEF > 40% (HFmrEF and HFpEF) to reduce the risk of HF hospitalization or CV death. (COR: 1, LOE: A)
	SGLT2i are recommended in patients with T2DM with multiple ASCVD risk factors or established ASCVD to reduce the risk of HF hospitalization. (COR: 1, LOE: A)

ADA: American Diabetes Association; AACE: American College of Clinical Endocrinologists; ACC/AHA: American College of Cardiology/American Heart Association; ESC: European Society pf Cardiology; HFrEF: Heart Failure with reduced ejection fraction; HFmrEF: Heart Failure with mildly reduced ejection fraction; HFpEF: Heart failure with preserved ejection fraction; COR: Class of recommendation; LOE: Level of evidence; T2DM: Type 2 diabetes mellitus; ASCVD: Atherosclerotic cardiovascular disease; SGLT2i: Sodium glucose cotransporter 2 inhibitors; LV: Left ventricle.