Which statement about SGLT2 inhibitors in heart failure is correct?

• A. They are only used to treat diabetes with no cardiovascular benefit.
• B. They only benefit HFrEF, not HFpEF.
• C. They are contraindicated in HF due to hypotension risk.
• D. They reduce hospitalization for heart failure and cardiovascular death across HFrEF and HFpEF.

Answer: (D)

SGLT2 inhibitors provide cardiovascular benefits in heart failure beyond glucose control. They reduce hospitalization for heart failure and cardiovascular death in patients with both reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). This has been shown in major trials such as DAPA-HF and EMPEROR-Reduced for HFrEF, and EMPEROR-Preserved and DELIVER for HFpEF, with benefits seen even in patients without diabetes. Mechanistically, they promote natriuresis and diuresis, improve renal hemodynamics, and may favorably affect myocardial energy use and remodeling, all contributing to better outcomes and symptoms. They are not contraindicated in heart failure due to hypotension risk; although they can cause volume depletion and lower blood pressure in some patients, the overall effect in heart failure is beneficial with appropriate monitoring. They are not limited to diabetes management with no cardiovascular benefit.