MicroRNAs and SGLT2 inhibitors in cardiovascular disease: Shared pathways and emerging roles

MicroRNAs are non-coding RNA sequences capable of transport outside the cell to regulate essential cellular processes. They are able to induce structural changes implicated in prevalent cardiovascular conditions such as heart failure, atherosclerosis and myocardial ischemia. SGLT2 inhibitors are newer anti-diabetic drugs used in the prevention and treatment of cardiovascular disease, which modulate metabolic pathways shared with microRNAs. Direct evidence linking a mechanistic relationship between microRNAs and SGLT2 inhibitors is limited. However, they share multiple pathways affecting key cellular processes implicated in cardiovascular disease progression, such as fibrosis and inflammation. This mini-review explores the effects of microRNAs on cardiac disease, with potential implications in cardiovascular disease management. Shared mechanisms between microRNAs and SGLT2 inhibitors and subsequent impact on heart failure development will be emphasized throughout. Certain microRNAs implicated in cardiovascular disease could potentially serve as diagnostic and therapeutic targets. Future use of microRNA-based technologies may include biomarker panels of circulating microRNAs and exosomal delivery of therapeutic microRNAs. However, these technologies are not fully developed, as the majority of relevant studies are preclinical. Possible future applications of biomarker panels in precision medicine include diagnosis and risk stratification of patients for cardiac disease progression, monitoring response to heart failure therapies, and identification of microRNA targets for modulation.