Cardioprotective effects of SGLT2 inhibitors on cardiac dysfunction in cancer patients receiving anthracycline chemotherapy: a systematic review

Background: Anthracyclines have been associated with cancer-therapy related cardiac dysfunction (CTRCD). Sodium-glucose co-transporter 2 (SGLT2) inhibitors are potential cardioprotective agents that could reduce cardiotoxicity in cancer patients receiving anthracyclines. This review aims to report the cardioprotective effects of SGLT2 inhibitors on CTRCD in cancer patients receiving anthracycline chemotherapy. Methods: This study is a systematic review written according to PRISMA guidelines. We searched PubMed, Scopus, and DOAJ on July 24th, 2024, for studies that compared heart failure (HF) hospitalisations and overall mortality between cancer patients with a history of anthracycline therapy who received SGLT2 inhibitor treatment and those without. Results: Three studies included in our review found that subjects in the SGLT2 inhibitor treatment group had fewer hospitalisations due to HF and lower overall mortality than those in the non-SGLT2 inhibitor treatment group. The cardioprotective effects of SGLT2 inhibitors are achievable mainly through their ability to attenuate oxidative stress, mitochondrial dysfunction, apoptosis, and infl ammation induced by anthracycline toxicity. Conclusions: Cohort studies have shown that SGLT2 inhibitors exhibit cardioprotective effects in cancer patients receiving anthracycline chemotherapy through their extensive pharmacodynamics. However, available studies are limited to cancer patients with preexisting type 2 diabetes mellitus (T2DM). Hence, future trials tailored to the general population are highly needed to yield results with greater validity.