Journal Publication

SGLT2 inhibitors cut heart failure hospitalization after MI without diabetes

A meta-analysis of 9,135 patients across five randomized trials found SGLT2 inhibitors lowered first heart failure hospitalization and raised LVEF after acute MI in patients without diabetes, with no mortality difference.

A meta-analysis of five randomized controlled trials found SGLT2 inhibitors reduced first heart failure hospitalization and improved left ventricular ejection fraction after acute myocardial infarction in patients without diabetes.

By AppliedXLJuly 19, 2026

Executive Summary

Pooling randomized trial data, SGLT2 inhibitors given after a heart attack lowered the rate of first heart failure hospitalization and improved a measure of heart pumping function in patients who did not have diabetes.
The same pooled analysis found no difference in deaths from any cause, or in the combined rate of hospitalization and death, so the benefit demonstrated here is a hospitalization and cardiac-function signal rather than a survival benefit.
SGLT2 inhibitors already carry heart failure and kidney disease benefits established in patients with diabetes; this analysis tests whether that benefit extends to a broader population immediately after a heart attack, before heart failure or diabetes are present.
The result supports further trials testing SGLT2 inhibitors specifically in this early post-heart-attack, non-diabetic population, rather than establishing the drug class as a settled standard of care there.

The question

SGLT2 inhibitors, a class of drugs that block glucose reabsorption in the kidney, have shown cardiovascular benefits in heart failure patients who have diabetes or chronic kidney disease. Their effect in patients without diabetes or preexisting heart failure who have just had an acute myocardial infarction (heart attack) has been understudied, according to the analysis. The meta-analysis set out to pool the existing randomized evidence in that specific population to test whether the same cardiovascular protection extends there. Sodium-Glucose

How it was done

The analysis queried MEDLINE, Scopus, the Cochrane Library, and ClinicalTrials.gov through August 2025 to identify randomized controlled trials of SGLT2 inhibitors following acute myocardial infarction in patients without diabetes. It pooled data using a random-effects model, reporting risk ratios for binary outcomes and mean differences for continuous measures, each with 95% confidence intervals. Five trials met inclusion criteria, contributing 9,135 patients in total: 4,581 assigned to an SGLT2 inhibitor and 4,554 to placebo. Sodium-Glucose

The result

SGLT2 inhibitors were associated with a reduced rate of first heart failure hospitalization, with a risk ratio of 0.74 (p=0.02). Left ventricular ejection fraction, a measure of the heart's pumping function, improved by a mean difference of 2.08 points (p=0.002), and NT-proBNP, a blood marker of cardiac stress, fell by a mean difference of 12.81 (p<0.0001). The analysis found no difference between arms in all-cause mortality, or in the composite of first heart failure hospitalization combined with all-cause mortality. Sodium-Glucose

What it changes

The authors concluded that in non-diabetic patients without heart failure, SGLT2 inhibitors significantly reduce first heart failure hospitalization and improve ejection fraction following acute myocardial infarction, and they called for further research into the cardiovascular benefits of SGLT2 inhibitors in this population. That framing positions the finding as hypothesis-supporting for a population beyond the drug class's established diabetes and heart-failure indications, built on a hospitalization and surrogate-marker effect rather than a demonstrated mortality benefit. Sodium-Glucose

This analysis was produced using AI-assisted reporting systems, AppliedXL data, and official public records. These systems undergo editorial review, quality checks, and regular audits by human experts. Errors may still occur, as with any automated system. Always consult the linked primary sources. Read our AI Editorial Policy.