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5,28,29 SGLT2 inhibitors are therefore particularly useful for diabetic patients with HF.3 Moreover, attenuation in endothelial dysfunction and arterial stiffness by reducing oxidative stress has also been reported, bringing potential benefits in vascular diseases.29,30 Dapagliflozin and empagliflozin have also shown anti-fibrotic effects in rats and human cardiac fibroblasts.31,32 Importantly, SGLT2 inhibitors induce weight loss and increase HDL levels in trials.11,12,26 They also increase lipolysis and reduce inflammation in adipose tissues.33 The switch from utilisation of glucose to ketones is also believed to be beneficial, especially for cardiac metabolism.5 All of these mechanisms may help to explain the cardiovascular benefits observed.11,12 The DAPA-HF and the EMPEROR-Reduced (NCT03057977) trials showed statistically significant reductions in HF hospitalisation, regardless of history of diabetes.34 However, the change in mortality did not reach statistical significance in EMPEROR-Reduced.35 The cardioprotective mechanisms independent of glucose lowering are still not fully understood

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