Sodium-Glucose Cotransporter 2 Inhibitors for the Prevention of Cardiovascular Events in Adults With Type 2 Diabetes Without Established Cardiovascular Disease: An Integrative Review
DOI:
https://doi.org/10.66201/ss.v1.10Keywords:
SGLT2 Inhibitors, Type 2 Diabetes Mellitus, Primary Cardiovascular Prevention, Major Cardiovascular Events, Renal Function, CardioprotectionAbstract
Background: Type 2 diabetes mellitus (T2DM) represents a global pandemic where cardiovascular (CV) complications are the leading cause of death. Although sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors) have demonstrated cardiorenal benefits, the evidence initially focused on secondary prevention. The aim of this integrative review was to synthesize the efficacy of SGLT2 inhibitors in the primary prevention of CV events in adults with T2DM without established CV disease.
Methods: An integrative review methodology was used, retrieving studies published between 2020 and 2025. Fifty-six studies were included, predominantly post-hoc analyses of clinical trials, involving more than 125,000 participants. Methodological quality was rigorously assessed using validated tools.
Results: SGLT2 inhibitors demonstrated robust cardiovascular and renal benefits. A statistically significant 14% reduction in the risk of major adverse cardiovascular events (MACE) was observed, the most notable effect being a 31% decrease in hospitalizations for heart failure. Furthermore, treatment was associated with nephroprotection, evidenced by a 39% reduction in the composite renal outcome and preservation of renal function. A 15% reduction in all-cause mortality was also documented. These effects were independent of baseline glycemic control and are attributed to pleiotropic mechanisms, such as blood pressure reduction, weight loss, and attenuation of systemic inflammation. The safety profile was favorable, with genitourinary fungal infection being the most frequent adverse event.
Conclusions: SGLT2 inhibitors provide tangible cardiorenal and survival benefits in the primary prevention of type 2 diabetes. It is imperative to update clinical guidelines and establish public health policies, including price negotiation and inclusion on essential medicines lists, to address disparities and facilitate equitable and universal access to these therapies.
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Copyright (c) 2026 Karina De Sousa Gomes, Potira Paz de Souza, Nayane Parente Lima Pieretti, Emerson Aragão Almeida, Rogério Bernardo, Walter Queiroz Maia Filho, Paola Fernanda Fedatto, Andrea Paola Britos Gómez
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