Molecular aspects of SGLT2 inhibitor interactions in myocardial failure

Abstract Heart failure is a major public health issue and one of the leading causes of morbidity and mortality world-wide. Despite significant advances in heart failure treatment and improved patient prognosis, the effectiveness of standard therapies remains limited, prompting the search for new solutions. One of these are sodium-glucose co-transporter 2 inhibitors, initially introduced for the treatment of type 2 diabetes. They have demonstrated beneficial effects on the clinical course of heart failure, independent of the presence of carbohydrate metabolism disorders. Their mechanisms of action extend far beyond the hypoglycemic effect and involve multidimensional molecular processes. The most important include: modulation of cardiomyocyte energy metabolism, regulation of ionic homeostasis, effects on cardiac remodeling, and reduction of oxidative stress and inflammatory response. An increasing number of clinical studies confirm the role of these molecular effects in improving outcomes for HF patients. Understanding the complex mechanisms of sodium-glucose co-transporter 2 inhibitors provides new therapeutic opportunities and reinforces their position as a cornerstone of pharmacological heart failure management.