Sodium-Glucose Cotransporter-2 Inhibitors in Anthracycline-Treated Cancer Patients: A Narrative Review of Emerging Cardioprotective Evidence

Randomized controlled trials (RCTs) evaluating the cardioprotective effects of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on cancer therapy-related cardiac dysfunction (CTRCD) are scarce. This narrative review synthesizes the available evidence from six primary clinical studies (n=21,523), all of which are observational or non-randomized, and places these findings within their mechanistic and clinical context. Across studies, SGLT2i use is consistently associated with lower rates of cardiovascular events, including heart failure (HF) hospitalization and imaging-defined cardiac dysfunction. However, all estimates are subject to substantial residual confounding, including healthy user bias and immortal time bias, and should be considered hypothesis-generating rather than causal. The magnitude of observed associations exceeds what is mechanistically plausible based on established HF trials, further supporting the likelihood of bias. Current evidence therefore does not support routine clinical use of SGLT2i for CTRCD prevention. Three ongoing randomized trials will determine whether these observational signals translate into clinical benefit and define the role of SGLT2i in cardio-oncology practice.