Efficacy and Safety of Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) in Cardiac Amyloidosis: A Systematic Review.

SGLT2 inhibitor use was associated with a significant reduction in all-cause mortality in cardiac amyloidosis patients.

• Pooled hazard ratio for all-cause mortality was HR 0.64 (95% CI 0.57–0.71)
• Analysis included five studies comprising 17,416 patients
• Mean patient age was 76.8 years and 78% were male
• Studies were identified through a comprehensive search of PubMed, Embase, Google Scholar, ScienceDirect, and Cochrane Library through June 2025

SGLT2 inhibitor use was associated with a significant reduction in stroke risk in cardiac amyloidosis patients.

• Pooled hazard ratio for stroke was HR 0.64 (95% CI 0.54–0.77)
• The confidence interval excludes 1.0, indicating statistical significance
• This finding was drawn from the same pool of five studies with 17,416 patients
• The patient population was predominantly male (78%) with a mean age of 76.8 years

There was a non-statistically significant trend toward reduction in hospitalization for heart failure with SGLT2 inhibitor use.

• Pooled hazard ratio for hospitalization due to heart failure was HR 0.88 (95% CI 0.76–1.02)
• The confidence interval crosses 1.0, indicating the result did not reach statistical significance
• The authors described this as 'a trend toward benefit'

SGLT2 inhibitor use was associated with a modest, non-statistically significant reduction in kidney failure risk.

• Pooled hazard ratio for kidney failure was HR 0.91 (95% CI 0.71–1.08)
• The confidence interval crosses 1.0, indicating the result did not reach statistical significance
• The reduction was characterized as 'modest'

The systematic review included five studies with 17,416 patients with cardiac amyloidosis evaluated for SGLT2 inhibitor outcomes.

• Literature search was conducted across PubMNet, Embase, Google Scholar, ScienceDirect, and Cochrane Library through June 2025
• The review was conducted in accordance with PRISMA guidelines
• Data extraction and quality assessment were performed independently by two reviewers
• Overall study quality was rated as moderate
• The most common amyloidosis subtypes were transthyretin (ATTR) and immunoglobulin light chain (AL)

Current evidence on SGLT2 inhibitors in cardiac amyloidosis is limited by observational study designs and heterogeneity.

• All five included studies were observational in design
• The authors noted heterogeneity across studies as a limitation
• Overall study quality was described as moderate
• The authors concluded that 'high-quality randomized controlled trials are needed to confirm these findings and guide clinical practice'