SGLT2 Inhibitors' Effects on Biomarkers of Myocardial Injury: A Systematic Review.

There is a lack of clinical data regarding sodium-glucose cotransporter-2 (SGLT2) inhibitors' effects on myocardial injury, a common clinical condition that deteriorates patient prognosis. Hence, this systematic review aims to investigate the effects of SGLT2 inhibitors on myocardial injury, using the cardiac injury biomarkers, particularly high-sensitivity cardiac troponin (hs-cTn). We performed a literature review on Embase, MEDLINE (PubMed), and the Cochrane Library, up to May 27, 2025. All potentially relevant randomized clinical trials (RCTs) assessing the effects of SGLT2 inhibitors on myocardial injury in individuals with diabetes or cardiovascular diseases were identified. The outcome measures were the most relevant cardiac injury biomarkers, including hs-cTnT and hs-cTnI, creatine kinase (CK)-MB, heart-type fatty acid-binding protein (H-FABP), myoglobin, lactate dehydrogenase (LDH), ischemia-modified albumin, and glycogen phosphorylase BB. In total, 1770 articles were identified through the literature search. After eliminating duplicates and screening articles, 10 studies involving 10440 participants were included. Of them, 6 studies evaluated hs-cTnT and 4 studies evaluated hs-cTnI. Among individuals with type 2 diabetes mellitus (T2DM), four of six trials showed significant attenuation in hs-cTn rise with SGLT2 inhibitors. In contrast, studies on HFrEF populations reported no significant change in hs-cTn levels. One study, including patients with acute myocardial infarction, also did not demonstrate a significant effect on hs-cTnI. The outcomes of this systematic review may suggest the potential effects of SGLT2 inhibitors in reducing myocardial injury by lowering hs-cTn levels in T2DM individuals. However, more studies are recommended to provide robust evidence.