Cardiovascular Atlas
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SGLT2 inhibitors (drug class)

A group of pills that NHLBI says were approved for diabetes because they lower blood sugar. Four trials in this atlas tested dapagliflozin or empagliflozin in adults with heart failure. In each, the drug group had a lower rate than the placebo group of cardiovascular death or worsening heart failure. The abstracts report the results in people with and without diabetes. Two of the trials enrolled people with an ejection fraction of 40% or less and two enrolled people above 40%.

Also called Sodium-glucose cotransporter 2 inhibitors

  • Drug
  • In this atlas

Overview

Technical summary

FDA classes in RxClass for dapagliflozin and empagliflozin: mechanism-of-action class Sodium-Glucose Transporter 2 Inhibitors and established pharmacologic class Sodium-Glucose Cotransporter 2 Inhibitor. The MeSH heading D000077203 is an exact match. This is the shared class page: the diabetes and kidney trials of the same medicines sit in other areas of the atlas. Class-level results are a side-by-side list of four trial results and not a pooled analysis.

About this drug

Level
Class
Mechanism
The FDA mechanism-of-action class for dapagliflozin and empagliflozin in RxClass is Sodium-Glucose Transporter 2 Inhibitors.

Claims and evidence

Context Adults with chronic heart failure in four placebo-controlled SGLT2 inhibitor trials, ejection fraction 40% or less in two and above 40% in two

Recipient
Adult
Population
Adults with chronic heart failure in four separate trials: DAPA-HF and EMPEROR-Reduced (ejection fraction of 40% or less) and EMPEROR-Preserved and DELIVER (ejection fraction of more than 40%). Each trial added the SGLT2 inhibitor or placebo to recommended or usual therapy. The abstracts say findings were similar or consistent in people with and without diabetes. This context joins four trials for comparison and is not a pooled analysis.
Care setting
Not stated in the abstract. The registry record is not read for setting.
Geography
Multinational trials.
Life stage
Adults.
Follow-up
Median follow-up differs by trial: 18.2 months, 16 months, 26.2 months and 2.3 years (abstracts).
Eligibility: 2 inclusion criteria; 1 exclusion criterion
Included
  • Chronic heart failure
  • Ejection fraction of 40% or less (two trials) or more than 40% (two trials)
Excluded
  • Entry and exclusion rules differ by trial and were not read in full

  • Effect Interventional Certainty not assessed

    In four separate placebo-controlled trials in adults with chronic heart failure, the primary outcome was lower with an SGLT2 inhibitor than with placebo. The primary outcome was a composite of cardiovascular death and worsening heart failure, defined slightly differently in each trial. The hazard ratios (95% confidence intervals) were: DAPA-HF, dapagliflozin, ejection fraction 40% or less, 0.74 (0.65 to 0.85); EMPEROR-Reduced, empagliflozin, 40% or less, 0.75 (0.65 to 0.86); EMPEROR-Preserved, empagliflozin, above 40%, 0.79 (0.69 to 0.90); DELIVER, dapagliflozin, above 40%, 0.82 (0.73 to 0.92). The abstracts report the benefit or its consistency in people with and without diabetes. In DELIVER, cardiovascular death on its own had a hazard ratio of 0.88 (0.74 to 1.05), and in EMPEROR-Preserved the effect was mainly related to fewer hospitalizations for heart failure. This lists four trial results side by side. It is not a pooled analysis.

    Applies to Adult
    • Adults with chronic heart failure in four separate trials: DAPA-HF and EMPEROR-Reduced (ejection fraction of 40% or less) and EMPEROR-Preserved and DELIVER (ejection fraction of more than 40%). Each trial added the SGLT2 inhibitor or placebo to recommended or usual therapy. The abstracts say findings were similar or consistent in people with and without diabetes. This context joins four trials for comparison and is not a pooled analysis.
    • Not stated in the abstract. The registry record is not read for setting.
    • Multinational trials.
    • Adults.
    Follow-up Median follow-up differs by trial: 18.2 months, 16 months, 26.2 months and 2.3 years (abstracts).
    Certainty method
    Not assessed
    Limitations
    The hazard ratios are the trials' own and were not pooled or re-analysed. The trials differ in entry criteria, in the drug, in the definition of the primary outcome and in follow-up. All four were funded by the drug makers. Numbers come from the PubMed abstracts; full texts were not read. Harms differ by trial and are given on the trial claims (genital and urinary tract infections and low blood pressure with empagliflozin in EMPEROR-Preserved; genital tract infection with empagliflozin in EMPEROR-Reduced). No certainty rating was assessed.
    Last checked
    2026-10-14
    Next evidence check due
    Not scheduled
    Sources and citations (18)

    1. Supports Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2019-11-21 · DOI: 10.1056/NEJMoa1911303 · PMID: 31535829

      Locator
      Abstract, RESULTS, sentence 1
      How it applies
      DAPA-HF primary outcome. Abstract of the paper from PubMed; the full text was not read.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      d86f142d100d12573e1bc9993fbf40729a81ab213219aa50b1d716709bcb2b4c
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    2. Supports Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2019-11-21 · DOI: 10.1056/NEJMoa1911303 · PMID: 31535829

      Locator
      Abstract, RESULTS, sentence 4
      How it applies
      DAPA-HF: diabetes and no diabetes. Abstract of the paper from PubMed; the full text was not read.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      d86f142d100d12573e1bc9993fbf40729a81ab213219aa50b1d716709bcb2b4c
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    3. Supports Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2020-10-08 · DOI: 10.1056/NEJMoa2022190 · PMID: 32865377

      Locator
      Abstract, RESULTS, sentence 1
      How it applies
      EMPEROR-Reduced primary outcome. Abstract of the paper from PubMed; the full text was not read.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      6519ae8338ccd9e7fb161e306e177ad9a66f171c96ee4da655099894e0ff9ea8
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    4. Supports Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2020-10-08 · DOI: 10.1056/NEJMoa2022190 · PMID: 32865377

      Locator
      Abstract, RESULTS, sentence 2
      How it applies
      EMPEROR-Reduced: consistency with and without diabetes. Abstract of the paper from PubMed; the full text was not read.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      6519ae8338ccd9e7fb161e306e177ad9a66f171c96ee4da655099894e0ff9ea8
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    5. Supports Empagliflozin in Heart Failure with a Preserved Ejection Fraction

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2021-10-14 · DOI: 10.1056/NEJMoa2107038 · PMID: 34449189

      Locator
      Abstract, RESULTS, sentence 1
      How it applies
      EMPEROR-Preserved primary outcome. Abstract of the paper from PubMed; the full text was not read.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      6aa150f130383577608a2ceaeb9d3d7329eda3f870a9438e7b8407f7c2904970
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    6. Supports Empagliflozin in Heart Failure with a Preserved Ejection Fraction

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2021-10-14 · DOI: 10.1056/NEJMoa2107038 · PMID: 34449189

      Locator
      Abstract, RESULTS, sentence 2
      How it applies
      EMPEROR-Preserved: the effect was mainly related to fewer hospitalizations. Abstract of the paper from PubMed; the full text was not read.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      6aa150f130383577608a2ceaeb9d3d7329eda3f870a9438e7b8407f7c2904970
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    7. Supports Empagliflozin in Heart Failure with a Preserved Ejection Fraction

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2021-10-14 · DOI: 10.1056/NEJMoa2107038 · PMID: 34449189

      Locator
      Abstract, RESULTS, sentence 3
      How it applies
      EMPEROR-Preserved: with or without diabetes. Abstract of the paper from PubMed; the full text was not read.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      6aa150f130383577608a2ceaeb9d3d7329eda3f870a9438e7b8407f7c2904970
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    8. Supports Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2022-09-22 · DOI: 10.1056/NEJMoa2206286 · PMID: 36027570

      Locator
      Abstract, RESULTS, sentence 1
      How it applies
      DELIVER primary outcome. Abstract of the paper from PubMed; the full text was not read.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      dc08c7ab7f6bbc362609a3289933d82906b3e850a2a2fac0185761b6fe5af947
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    9. Supports Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2022-09-22 · DOI: 10.1056/NEJMoa2206286 · PMID: 36027570

      Locator
      Abstract, RESULTS, sentence 2
      How it applies
      DELIVER: cardiovascular death on its own. Abstract of the paper from PubMed; the full text was not read.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      dc08c7ab7f6bbc362609a3289933d82906b3e850a2a2fac0185761b6fe5af947
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    10. Supports Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2022-09-22 · DOI: 10.1056/NEJMoa2206286 · PMID: 36027570

      Locator
      Abstract, RESULTS, sentence 4
      How it applies
      DELIVER: ejection fraction and diabetes subgroups. Abstract of the paper from PubMed; the full text was not read.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      dc08c7ab7f6bbc362609a3289933d82906b3e850a2a2fac0185761b6fe5af947
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    11. Background Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2019-11-21 · DOI: 10.1056/NEJMoa1911303 · PMID: 31535829

      Locator
      Abstract, METHODS, sentence 1
      How it applies
      DAPA-HF: who was randomized. Abstract of the paper from PubMed; the full text was not read.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      d86f142d100d12573e1bc9993fbf40729a81ab213219aa50b1d716709bcb2b4c
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    12. Background Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2019-11-21 · DOI: 10.1056/NEJMoa1911303 · PMID: 31535829

      Locator
      Abstract, METHODS, sentence 2
      How it applies
      DAPA-HF: how the primary outcome was defined. Abstract of the paper from PubMed; the full text was not read.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      d86f142d100d12573e1bc9993fbf40729a81ab213219aa50b1d716709bcb2b4c
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    13. Background Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2020-10-08 · DOI: 10.1056/NEJMoa2022190 · PMID: 32865377

      Locator
      Abstract, METHODS, sentence 1
      How it applies
      EMPEROR-Reduced: who was randomized. Abstract of the paper from PubMed; the full text was not read.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      6519ae8338ccd9e7fb161e306e177ad9a66f171c96ee4da655099894e0ff9ea8
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    14. Background Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2020-10-08 · DOI: 10.1056/NEJMoa2022190 · PMID: 32865377

      Locator
      Abstract, METHODS, sentence 2
      How it applies
      EMPEROR-Reduced: how the primary outcome was defined. Abstract of the paper from PubMed; the full text was not read.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      6519ae8338ccd9e7fb161e306e177ad9a66f171c96ee4da655099894e0ff9ea8
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    15. Background Empagliflozin in Heart Failure with a Preserved Ejection Fraction

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2021-10-14 · DOI: 10.1056/NEJMoa2107038 · PMID: 34449189

      Locator
      Abstract, METHODS, sentence 1
      How it applies
      EMPEROR-Preserved: who was randomized. Abstract of the paper from PubMed; the full text was not read.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      6aa150f130383577608a2ceaeb9d3d7329eda3f870a9438e7b8407f7c2904970
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    16. Background Empagliflozin in Heart Failure with a Preserved Ejection Fraction

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2021-10-14 · DOI: 10.1056/NEJMoa2107038 · PMID: 34449189

      Locator
      Abstract, METHODS, sentence 2
      How it applies
      EMPEROR-Preserved: how the primary outcome was defined. Abstract of the paper from PubMed; the full text was not read.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      6aa150f130383577608a2ceaeb9d3d7329eda3f870a9438e7b8407f7c2904970
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    17. Background Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2022-09-22 · DOI: 10.1056/NEJMoa2206286 · PMID: 36027570

      Locator
      Abstract, METHODS, sentence 1
      How it applies
      DELIVER: who was randomized. Abstract of the paper from PubMed; the full text was not read.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      dc08c7ab7f6bbc362609a3289933d82906b3e850a2a2fac0185761b6fe5af947
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    18. Background Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction

      Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2022-09-22 · DOI: 10.1056/NEJMoa2206286 · PMID: 36027570

      Locator
      Abstract, METHODS, sentence 2
      How it applies
      DELIVER: how the primary outcome was defined. Abstract of the paper from PubMed; the full text was not read.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      dc08c7ab7f6bbc362609a3289933d82906b3e850a2a2fac0185761b6fe5af947
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

Record details

Record id
cardio:sglt2-inhibitors
Content hash
1c4f4b93cad87d03eb954445230f71e4eb1b17269bd25f9cf72a29906a4b32d2