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Effects of sodium-glucose cotransporter 2 inhibitors on cardiomyopathy: a meta-analysis
Bo Xu1,2,3,4,5, Tianqiao Zhang1,2,3,4,5, Jiecan Zhou6,7,8,9,10
1The First Affiliated Hospital, Hunan Provincial Clinical Medical Research Center for Drug Evaluation of Major Chronic Diseases, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
Background:
Cardiomyopathies can present at any age and affect individuals and families across the entire life course. Clinical effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors on cardiomyopathy have not yet been fully elucidated.
Objective:
The primary objective of this study was to investigate whether SGLT2 inhibitors have an effect on cardiomyopathy compared to placebo.
Methods:
We systematically searched for randomized double-blind placebo-controlled trials on PubMed, Web of Science, EU Clinical Trials Register, and ClinicalTrials.gov. We used the Mantel-Haenszel statistical method, fixed-effects model and risk ratio (RR) with 95% confidence intervals (CI) to analyze binary data.
Results:
A total of 19 studies were included, covering 97,035 participants. Compared to placebo, SGLT2 inhibitors were associated with a reduced risk of cardiomyopathy (RR 0.72; 95% CI 0.56-0.92; P < 0.01; high certainty of evidence), with non-significant heterogeneity (Pheterogeneity=0.81; I2 = 0%), especially observed in the empagliflozin subgroup (RR 0.66; 95% CI 0.46-0.94; P = 0.02), chronic kidney disease (RR 0.67; 95% CI 0.47-0.97; P = 0.03) population and heart failure (RR 0.46; 95% CI 0.23-0.91; P = 0.03) population. However, in type 2 diabetes mellitus population, the effect of SGLT2 inhibitors on cardiomyopathy incidence was less clear (RR 0.76; 95% CI 0.51-1.12; P = 0.17; moderate certainty of evidence). Additionally, SGLT2 inhibitors were associated with a reduced risk of primary cardiomyopathy (RR 0.43; 95% CI 0.21-0.87; P = 0.02) and slightly decreased the incidence of secondary cardiomyopathy compared to placebo (RR 0.75; 95% CI 0.56-1.01; P = 0.06).
Conclusions:
SGLT2 inhibitors significantly reduced the risk of cardiomyopathy, which further enhances the cardiovascular benefits of SGLT2 inhibitors in clinical settings, especially for patients with heart failure and chronic kidney disease.
Insights
Sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly reduce cardiomyopathy risk. These findings highlight their cardiovascular benefits, particularly for patients with heart failure and chronic kidney disease.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Cardiomyopathies affect all age groups and have lifelong implications.
- The impact of sodium-glucose cotransporter 2 (SGLT2) inhibitors on cardiomyopathy requires further clarification.
Purpose of the Study:
- To evaluate the efficacy of SGLT2 inhibitors in reducing cardiomyopathy risk compared to placebo.
Main Methods:
- Systematic review of randomized, double-blind, placebo-controlled trials from major databases.
- Meta-analysis using Mantel-Haenszel method with fixed-effects model and risk ratios (RR) with 95% confidence intervals (CI).
Main Results:
- SGLT2 inhibitors reduced cardiomyopathy risk by 28% (RR 0.72; 95% CI 0.56-0.92) with high certainty.
- Significant risk reduction observed in empagliflozin subgroup, chronic kidney disease, and heart failure populations.
- Effect was less clear in type 2 diabetes mellitus population; reduced risk of primary and secondary cardiomyopathy noted.
Conclusions:
- SGLT2 inhibitors demonstrate a significant protective effect against cardiomyopathy.
- These findings reinforce the cardiovascular advantages of SGLT2 inhibitors in clinical practice, especially for heart failure and CKD patients.
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