SGLT2 Inhibitors Promising for Heart Health in Seniors

Original Article: https://www.medscape.com/viewarticle/sglt2-inhibitors-promising-heart-health-seniors-2025a1000rlg

Background & Study Overview

A recent analysis looked at nine clinical trials conducted between 2015 and 2025 in older adults with cardiovascular disease, focusing on SGLT2 inhibitors (Dapagliflozin, Empagliflozin, and Sotagliflozin). The trials included nearly 25,000 participants and compared these medications with a placebo, assessing outcomes such as hospitalization or urgent visits for heart failure and cardiovascular death.

Key Findings

The analysis found that older adults treated with SGLT2 inhibitors had a significantly lower risk of the combined outcome of heart-failure-related hospitalization, urgent visits, and cardiovascular death. Secondary outcomes were also improved, including all-cause mortality, cardiovascular death, and hospitalization for heart failure. Benefits were seen consistently across subgroups, regardless of whether participants had heart failure, type 2 diabetes, or were aged 65–74 or 75 and older. On the safety side, SGLT2 inhibitors were associated with an increased risk of genital infections, but overall serious adverse events decreased in the age groups studied.

Practical Implications for Older Patients

Given the growing number of older adults with cardiovascular disease, these findings support the consideration of SGLT2 inhibitors as part of treatment in this population, provided careful monitoring is in place. For patients and clinicians, this may translate into fewer hospital admissions for heart failure, fewer urgent visits, reduced risk of cardiovascular death, and possibly better overall survival. At the same time, the increased risk of genital infections and other age-specific risks means shared decision-making and individualized assessment remain essential.

Limitations & Considerations

The trials generally included healthier older adults rather than very frail patients, and frailty status was often not fully evaluated. The studies also varied in how they defined cardiovascular outcomes, which may affect comparisons. As with any combined analysis, differences among trials and patient populations must be considered, and real-world applicability, especially in very old or frail patients, remains to be clarified.

Bottom Line

For older adults with cardiovascular disease, SGLT2 inhibitors are a promising therapeutic option that goes beyond glucose lowering to provide cardiovascular benefits. While not a one-size-fits-all solution, the evidence supports their use with careful monitoring and appropriate patient selection.