SGLT2 inhibitors in cardiac amyloidosis: mechanistic insights and clinical perspectives—a narrative review

SGLT2 inhibitors may offer a promising adjunctive approach in CA by targeting multiple disease mechanisms and improving overall cardiorenal balance. However, current evidence is based solely on non-randomized data, with low-to-moderate certainty for clinical outcomes such as mortality, HF hospitalization, and biomarker change. Across available studies, therapy was generally well tolerated, with low discontinuation rates and infrequent genitourinary or hypotensive events, consistent with safety profiles observed in broader HF populations. Dedicated amyloidosis-specific RCTs are required to establish efficacy and safety before routine implementation in clinical practice.