Molecular Mechanisms and Clinical Applications of SGLT2 Inhibitors in Cardiovascular Diseases

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have emerged as a vital therapy that bridges glycemic control and cardiovascular protection, fundamentally changing the way the Cardiovascular-Kidney-Metabolic (CKM) syndrome is managed. This review summarises the current evidence on the molecular mechanisms of SGLT2 inhibitors, ranging from haemodynamic regulation to metabolic reprogramming, and their clinical applications in various cardiovascular diseases. We critically discuss the pharmacological characteristics of different agents, as well as the debate surrounding glucose-dependent versus glucose-independent mechanisms. Furthermore, we summarise current guideline recommendations to provide clinicians with a reference for incorporating SGLT2 inhibitors into the treatment of heart failure and other cardiovascular conditions.