TOPLINE:

In older adults with cardiovascular disease, SGLT2 inhibitors significantly reduced the risk for the composite outcome of hospitalization or urgent visits for heart failure and cardiovascular death. The analysis showed a marked decrease in the risk for all-cause mortality but an increased risk for genital infections with SGLT2 inhibitors.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis of nine randomized controlled trials published between 2015 and 2025, focusing on SGLT2 inhibitors in 24,889 older adults aged 65 years or older with cardiovascular disease.
• SGLT2 inhibitors — empagliflozin, ertugliflozin, sotagliflozin, and dapagliflozin — were compared with placebo in populations with various comorbidities.
• The primary outcome was a composite of hospitalization or urgent visits for heart failure and cardiovascular death.
• Secondary outcomes included all-cause mortality, cardiovascular death, and hospitalization for heart failure, analyzed individually.
• Subgroup analyses were performed based on heart failure status, type 2 diabetes status, age group, and the type of SGLT2 inhibitor used.

TAKEAWAY:

• SGLT2 inhibitors significantly reduced the risk for the primary composite outcome in older adults with cardiovascular disease (hazard ratio [HR], 0.75; 95% CI, 0.67-0.83).
• Risks for secondary outcomes were also reduced with SGLT2 inhibitors: all-cause mortality (HR, 0.80; 95% CI, 0.66-0.97; three studies), cardiovascular death (HR, 0.78; 95% CI, 0.65-0.94; four studies), and hospitalization for heart failure (HR, 0.73; 95% CI, 0.65-0.83; four studies).
• SGLT2 inhibitors were associated with an increased risk for genital infections (risk ratio, 3.18; 95% CI, 2.35-4.30; three studies), particularly in patients aged 65-74 years and those aged 75 years or older; the risk for serious adverse events, evaluated in five studies, decreased with SGLT2 inhibitors in these age groups.
• Dapagliflozin, empagliflozin, and sotagliflozin were each associated with a significantly reduced risk for the primary outcome, with HRs of 0.77, 0.71, and 0.47, respectively. Subgroup analyses of studies involving only patients with heart failure, those with type 2 diabetes, or adults aged 65-74 years and 75 years or older showed a significant reduction in the risk for the primary outcome.

IN PRACTICE:

“Given the growing aging population and the high burden of cardiovascular disease in older adults, these findings support the use of SGLT2 inhibitors in this population with appropriate monitoring,” the authors of the study wrote.

SOURCE:

This study was led by Kota Minami of the Medical Training Center at the Saga University Hospital in Saga, Japan. It was published online on October 07, 2025, in the Journal of the American Geriatrics Society.

LIMITATIONS:

Participants in the trials were generally healthier than most older adults, and their frailty status was not evaluated. Different definitions of composite cardiovascular outcomes across studies may have affected the results.

DISCLOSURES:

No specific funding was received for this work, and the authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.