• Emanuel Raschi, Gian Paolo Fadini, Igor Diemberger, Elisabetta Poluzzi, and Fabrizio De Ponti.
• Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
• Expert Opin Pharmacother. 2021 Apr 1; 22 (5): 647-650.

AbstractIntroduction: In individuals with type 2 diabetes mellitus, sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of hospitalization for heart failure and serious adverse renal events, both in randomized controlled trials and observational studies.Areas covered: In this paper, the authors critically discuss the rationale, results, and implications of the recent placebo-controlled EMPEROR-Reduced trial [NCT03057977], which evaluated empagliflozin in subjects with chronic heart failure and a reduced ejection fraction (HFrEF), with or without diabetes. A parallel with the DAPA-HF trial, investigating dapagliflozin in a similar albeit not fully overlapping population, is also provided. The authors finally provide the reader with their expert perspectives.Expert opinion: EMPEROR-Reduced confirmed and extended the findings from DAPA-HF, especially on renal outcomes, thus strengthening the rationale for considering SGLT2 inhibitors among established treatments in HFrEF. Forthcoming guidelines supported by the knowledge of the clinical pharmacology of SGLT2 inhibitors will hopefully assist cardiologists, nephrologists, and general practitioners in selecting the target population and promoting safe prescribing.

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