Anti-atherosclerotic potential of SGLT2 inhibitors: what do the recent data show?
Authors:
Branislav Vohnout 1,2; Jana Lisičanová 1
Authors‘ workplace:
Metabolické centrum MUDr. Kataríny Rašlovej s. r. o., Bratislava
1; Koordinačné centrum pre FHLP, SZU v Bratislave
2; Biomedicínske centrum SAV, v. v. i., Bratislava
3; Fakulta verejného zdravotníctva SZU v Bratislave
4; Ústav lekárskej biológie, genetiky a klinickej genetiky LF UK a UNB, Bratislava
5
Published in:
AtheroRev 2026; 11(2): 100-103
Category:
Reviews
Overview
Atherosclerotic cardiovascular disease is the leading cause of death in patients with diabetes. In addition to their glucose-lowering effect, SGLT2 inhibitors have also been shown in clinical trials to reduce the incidence of cardiovascular events and even overall mortality. In addition to their effects on several classic risk factors for atherosclerosis, SGLT2i may influence atherosclerosis through multiple mechanisms, including effects on systemic inflammation, oxidative stress, autophagy, mitochondrial function, and endothelial dysfunction.
Keywords:
atherosclerosis-related cardiovascular disease (ARCAD) – Dutch Lipid Clinic Network (DLCN) – familial hypercholesterolemia (FH) – MedPed – monogenic familial hypercholesterolemia – Atherosclerosis – cardiovascular disease – SGLT2 inhibitor
Sources
- Informácie dostupné z WWW: <http://www.diabetesatlas.org>.
- Defronzo RA. Banting Lecture. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes 2009; 58(4): 773–795. Dostupné z DOI: <http://dx.doi.org/10.2337/db09–9028>.
- Cosentino F, Grant PJ, Aboyans V et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 2020; 41(2): 255–323. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehz486>.
- Mach F, Baigent C, Catapano AL et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Atherosclerosis 2019; 290 : 140–205. Dostupné z DOI: <http://dx.doi.org/10.1016/j.atherosclerosis.2019.08.014>.
- Sarwar N, Gao P, Seshasai SR et al. [Emerging Risk Factors Collaboration]. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010; 375(9733): 2215–2222. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(10)60484–9>.
- Borén J, Öörni K, Catapano AL. The link between diabetes and cardiovascular disease. Atherosclerosis 2024; 394 : 117607. Dostupné z DOI: <http://dx.doi.org/10.1016/j.atherosclerosis.2024.117607>.
- Mutruc V, Bologa C, Șorodoc V et al. Cardiovascular-kidney-metabolic syndrome: a new paradigm in clinical medicine or going back to basics? J Clin Med 2025; 14(8): 2833. Dostupné z DOI: <http://dx.doi.org/10.3390/jcm14082833>.
- Ceasovschih A, Balta A, Aldeen ES et al. Sodium-glucose cotransporter 2 inhibitors and atherosclerosis. Am J Prev Cardiol 2025; 23 : 101061. Dostupné z DOI: <http://dx.doi.org/10.1016/j.ajpc.2025.101061>.
- Ghezzi C, Loo DD, Wright EM. Physiology of renal glucose handling via SGLT1, SGLT2 and GLUT2. Diabetologia 2018; 61(10): 2087–2097. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125–018–4656–5>.
- Zinman B, Wanner C, Lachin JM et al. [EMPA-REG OUTCOME Investigators]. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015; 373(22): 2117–2128. Dostupné z DOI:<http://dx.doi.org/10.1056/NEJMoa1504720>.
- Wanner C, Inzucchi SE, Lachin JM et al. Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes. N Engl J Med 2016; 375(4): 323–334. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1515920>.
- Verma S, Leiter LA, Zinman B et al. (2021) Time to cardiovascular benefits of empagliflozin: a post hoc observation from the EMPA-REG OUTCOME trial. ESC Heart Failure 2021; 8(4): 2603–2607. Dostupné z DOI: <https://doi.org/10.1002/ehf2.13374>.
- Neal B, Perkovic V, Mahaffey KW et al. [CANVAS Program Collaborative Group]. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med 2017; 377(7): 644–657. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1611925>.
- Wiviott SD, Raz I, Bonaca MP et al. [DECLARE–TIMI 58 Investigators]. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2019; 380(4): 347–357. Dostupné z DOI:<http://dx.doi.org/10.1056/NEJMoa1812389>.
- [Nuffield Department of Population Health Renal Studies Group]. SGLT2 inhibitor Meta-Analysis Cardio-Renal Trialists’ Consortium. Impact of diabetes on the effects of sodium glucose co-transporter-2 inhibitors on kidney outcomes: collaborative meta-analysis of large placebo-controlled trials. Lancet 2022; 400(10365): 1788–1801 Dostupné z DOI:<https://doi.org/10.1016/S0140–6736(22)02074–8>.
- Preda A, Montecucco F, Carbone F et al. SGLT2 inhibitors: from glucose-lowering to cardiovascular benefits. Cardiovasc Res 2024; 120(5): 443–460. Dostupné z DOI: <http://dx.doi.org/10.1093/cvr/cvae047>.
- Han JH, Oh TJ, Lee G et al. The beneficial effects of empagliflozin, an SGLT2 inhibitor, on atherosclerosis in ApoE − / − mice fed a western diet. Diabetologia 2017; 60(2): 364–376. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125–016–4158–2>.
- Ganbaatar B, Fukuda D, Shinohara M et al. Empagliflozin ameliorates endothelial dysfunction and suppresses atherogenesis in diabetic apolipoprotein E-deficient mice. Eur J Pharmacol 2020; 875 : 173040. Dostupné z DOI: <http://dx.doi.org/10.1016/j.ejphar.2020.173040>.
- Terasaki M, Hiromura M, Mori Y et al. Amelioration of hyperglycemia with a sodium-glucose cotransporter 2 inhibitor prevents macrophage-driven atherosclerosis through macrophage foam cell formation suppression in type 1 and type 2 diabetic mice. PLoS One 2015; 10(11): e0143396. Dostupné z DOI:<http://dx.doi.org/10.1371/journal.pone.0143396>.
- Ferrannini E, Baldi S, Frascerra S et al. Shift to Fatty Substrate Utilization in Response to Sodium-Glucose Cotransporter 2 Inhibition in Subjects Without Diabetes and Patients With Type 2 Diabetes. Diabetes 2016; 65(5) :1190–1195. Dostupné z DOI:<http://dx.doi.org/10.2337/db15–1356>.
- Martinka E. Pleiotropné účinky inhibítorov SGLT2 a ich podstata. Forum Diab 2026; 15(1): 71–75.
- Hao H, Li Z, Qiao S et al.Empagliflozin ameliorates atherosclerosis via regulating the intestinal flora. Atherosclerosis 2023; 371 : 32–40. Dostupné z DOI: <http://dx.doi.org/10.1016/j.atherosclerosis.2023.03.011>.
- Ghanim H, Abuaysheh S, Hejna J et al. Dapagliflozin suppresses hepcidin and increases erythropoiesis. J Clin Endocrinol Metab 2020; 105(4): dgaa057. Dostupné z DOI: <http://dx.doi.org/10.1210/clinem/dgaa057>.
- Diallo A, Carlos-Bolumbu M, Galtier F. Blood pressure-lowering effects of SGLT2 inhibitors and GLP-1 receptor agonists for preventing of cardiovascular events and death in type 2 diabetes: a systematic review and meta-analysis. Acta Diabetol 2023; 60(12): 1651–1662. Dostupné z DOI: <https://doi.org/10.1007/s00592–023–02154–4>.
- Lee PC, Ganguly S, Goh SY. Weight loss associated with sodium-glucose cotransporter-2 inhibition: a review of evidence and underlying mechanisms. Obes Rev 2018; 19(12): 1630–1641. Dostupné z DOI: <https://doi.org/10.1111/obr.12755>.
- Wang X, Wu N, Sun C et al Effects of SGLT-2 inhibitors on adipose tissue distribution in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Diabetol Metab Syndr 2023; 15(1): 113. Dostupné z DOI: <https://doi.org/10.1186/s13098–023–01085-y>.
- Inzucchi SE, Davies MJ, Khunti K et al. Empagliflozin treatment effects across categories of baseline HbA1c, body weight, and blood pressure as an add-on to metformin in patients with type 2 diabetes. Diabetes Obes Metab 2021; 23(2): 425–433. Dostupné z DOI: <http://dx.doi.org/10.1111/dom.14234>.
- Matsushita K, Coresh J, Sang Y et al. [CKD Prognosis Consortium]. Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data. Lancet Diabetes Endocrinol 2015; 3(7): 514–525. Dostupné z DOI: <https://doi.org/10.1016/S2213–8587(15)00040–6>.
- Bechmann LE, Emanuelsson F, Nordestgaard BG et al. SGLT2-inhibition increases total, LDL, and HDL cholesterol and lowers triglycerides: Meta-analyses of 60 randomized trials, overall and by dose, ethnicity, and drug type. Atherosclerosis 2024; 394 : 117236. Dostupné z DOI: <http://dx.doi.org/10.1016/j.atherosclerosis.2023.117236>.
Labels
Angiology Diabetology Internal medicine Cardiology General practitioner for adultsArticle was published in
Athero Review
2026 Issue 2
-
All articles in this issue
- Kardiovaskulární prevence v každodenní praxi
- Consensus on the treatment of hyperuricemia in individuals at high cardiovascular risk – update 2025: brief summary
- Semaglutide in the 2026 European Society of Cardiology guidelines
- The level of control of cardiovascular risk factors in patients with type 2 diabetes and hypertension in the routine clinical practice of primary care physicians: results of the BEAT study
- Anti-atherosclerotic potential of SGLT2 inhibitors: what do the recent data show?
- The role of DLCN in the diagnosis of familial hypercholesterolemia: data from the MedPed Center in Bratislava
- Bempedoic acid in older adults: new data
- Lipoprotein(a) and ischemic stroke
- Nanoplastics – is this really a new risk factor for cardiovascular disease?
- Research on remarkable articles from international literature
- Six-month doctoral fellowship at the Renal and Cardiovascular Research Unit, University of Salamanca, made possible by ČSAT
- Šobra Day 2026: From the roots of lipidology to its future
- Athero Review
- Journal archive
- Current issue
- About the journal
Most read in this issue
- Kardiovaskulární prevence v každodenní praxi
- Consensus on the treatment of hyperuricemia in individuals at high cardiovascular risk – update 2025: brief summary
- The level of control of cardiovascular risk factors in patients with type 2 diabetes and hypertension in the routine clinical practice of primary care physicians: results of the BEAT study
- Semaglutide in the 2026 European Society of Cardiology guidelines