{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T02:33:11Z","timestamp":1792895591162,"version":"4.5.0"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T00:00:00Z","timestamp":1745539200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fondation Leducq Network of Excellence in Cardio-Oncology","id":[{"id":"https:\/\/ror.org\/01czwga19","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Royal Brompton Cardio-Oncology Centre of Excellence"},{"name":"The Big Heart Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Cardiovascular disease and cancer represent significant global health challenges. An overlap between oncology and cardiology is compounded by cancer therapies, which are known to have cardiotoxic effects. Sodium\u2013glucose cotransporter 2 inhibitors (SGLT2i), initially developed for treating diabetes, have shown promising cardiovascular benefits in non-cancer populations, particularly in preventing heart failure (HF) and reducing HF-related hospitalization and mortality in large randomized controlled trials (RCTs) across the spectrum of left ventricular ejection fraction. However, their potential cardioprotective role in cancer patients remains unclear. This systematic review and meta-analysis evaluated cardiovascular outcomes in cancer patients with type 2 diabetes undergoing chemotherapy with concomitant use of SGLT2i compared with those not using SGLT2i. Subgroup analyses were performed to explore patients without baseline HF and patients treated exclusively with anthracyclines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>A systematic review identified 11 observational retrospective studies (n = 104 327 patients). Based on the National Institutes of Health Quality Assessment Tool checklist, two studies were at moderate risk of bias, while all other included studies had a low risk of bias. Meta-analysis indicated that the use of SGLT2i was associated with a significant reduction in all-cause mortality [0.47, 95% confidence interval (CI) 0.33\u20130.67, P &amp;lt; 0.0001] and risk of HF hospitalization (0.44, 95% CI 0.27\u20130.72, P = 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The use of SGLT2i may be associated with a significant reduction in all-cause mortality and risk of HF hospitalization in actively treated cancer patients with Type 2 diabetes. Our study highlights the need for further investigation through prospective RCTs to confirm the efficacy and safety of SGLT2i in attenuating cardiotoxicity and supporting cardiovascular health in oncology settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcvp\/pvaf028","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T07:21:33Z","timestamp":1744701693000},"page":"343-352","source":"Crossref","is-referenced-by-count":22,"title":["Effects of sodium\u2013glucose cotransporter 2 inhibitors in patients with cancer and diabetes mellitus: a systematic review and meta-analysis"],"prefix":"10.1093","volume":"11","author":[{"given":"Giuseppina","family":"Novo","sequence":"first","affiliation":[{"name":"Cardiology Unit, University Hospital \u2018Paolo Giaccone\u2019 , Via del vespro 129, 90127 Palermo ,","place":["Italy"]},{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) University of Palermo , Piazza delle Cliniche 2, 90127 Palermo ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9151-4335","authenticated-orcid":false,"given":"Cristina","family":"Madaudo","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) University of Palermo , Piazza delle Cliniche 2, 90127 Palermo ,","place":["Italy"]},{"name":"Department of Cardiovascular Sciences, British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine, Faculty of Life Science, King\u2019s College London , The James Black Centre, 125 Coldharbour Lane, London SE5 9NU ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Cannat\u00e0","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine, Faculty of Life Science, King\u2019s College London , The James Black Centre, 125 Coldharbour Lane, London SE5 9NU ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7167-7287","authenticated-orcid":false,"given":"Pietro","family":"Ameri","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Genova , Viale Benedetto XV, 6, 16132 Genoa ,","place":["Italy"]},{"name":"IRCCS Ospedale Policlinico San Martino , Largo Rosanna Benzi, 10, 16132 Genoa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Di Lisi","sequence":"additional","affiliation":[{"name":"Cardiology Unit, University Hospital \u2018Paolo Giaccone\u2019 , Via del vespro 129, 90127 Palermo ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel I","family":"Bromage","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine, Faculty of Life Science, King\u2019s College London , The James Black Centre, 125 Coldharbour Lane, London SE5 9NU ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo Ruggero","family":"Galassi","sequence":"additional","affiliation":[{"name":"Cardiology Unit, University Hospital \u2018Paolo Giaccone\u2019 , Via del vespro 129, 90127 Palermo ,","place":["Italy"]},{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) University of Palermo , Piazza delle Cliniche 2, 90127 Palermo ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5678-6175","authenticated-orcid":false,"given":"Giorgio","family":"Minotti","sequence":"additional","affiliation":[{"name":"Department of Medicine and Unit of Clinical Pharmacology, University and Fondazione Policlinico Universitario Campus Bio-Medico , Via \u00c1lvaro del Portillo 200, 00128 Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander R","family":"Lyon","sequence":"additional","affiliation":[{"name":"Cardio-Oncology Centre of Excellence, Royal Brompton Hospital , Fulham Wing, Dovehouse Street, London SW3 6JY ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,4,25]]},"reference":[{"key":"2025070708270840000_pvaf028-B1","doi-asserted-by":"publisher","first-page":"832","DOI":"10.1001\/jamaoncol.2017.3605","article-title":"Prevalence of prior cancer among persons newly diagnosed with cancer: an initial report from the surveillance, epidemiology, and End results program","volume":"4","author":"Murphy","year":"2018","journal-title":"JAMA Oncol"},{"key":"2025070708270840000_pvaf028-B2","doi-asserted-by":"publisher","first-page":"2231","DOI":"10.1016\/j.jacc.2009.02.050","article-title":"Cardiovascular complications of cancer therapy: incidence, pathogenesis, diagnosis, and management","volume":"53","author":"Yeh","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"2025070708270840000_pvaf028-B3","doi-asserted-by":"publisher","first-page":"26","DOI":"10.3389\/fcvm.2020.00026","article-title":"Cardiotoxicity of anthracyclines","volume":"7","author":"Cardinale","year":"2020","journal-title":"Front Cardiovasc Med"},{"key":"2025070708270840000_pvaf028-B4","doi-asserted-by":"publisher","first-page":"4229","DOI":"10.1093\/eurheartj\/ehac244","article-title":"2022 ESC guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS)","volume":"43","author":"Lyon","year":"2022","journal-title":"Eur Heart J"},{"key":"2025070708270840000_pvaf028-B5","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/j.jacc.2009.03.095","article-title":"Anthracycline-induced cardiomyopathy: clinical relevance and response to pharmacologic therapy","volume":"55","author":"Cardinale","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"2025070708270840000_pvaf028-B6","doi-asserted-by":"publisher","first-page":"1981","DOI":"10.1161\/CIRCULATIONAHA.114.013777","article-title":"Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy","volume":"131","author":"Cardinale","year":"2015","journal-title":"Circulation"},{"key":"2025070708270840000_pvaf028-B7","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1345\/aph.1K359","article-title":"Monitoring of anthracycline-induced cardiotoxicity","volume":"42","author":"Jannazzo","year":"2008","journal-title":"Ann Pharmacother"},{"key":"2025070708270840000_pvaf028-B8","doi-asserted-by":"publisher","first-page":"986","DOI":"10.3390\/cancers15030986","article-title":"Global longitudinal strain in cardio-oncology: a review","volume":"15","author":"S\u0142awi\u0144ski","year":"2023","journal-title":"Cancers (Basel)"},{"key":"2025070708270840000_pvaf028-B9","doi-asserted-by":"publisher","first-page":"e15881","DOI":"10.1111\/echo.15881","article-title":"Assessment of cancer therapy-related cardiac dysfunction in breast cancer women using a new speckle tracking echocardiography Index: the GAVS","volume":"41","author":"Di Lisi","year":"2024","journal-title":"Echocardiography"},{"key":"2025070708270840000_pvaf028-B10","doi-asserted-by":"publisher","first-page":"1845","DOI":"10.1007\/s10554-023-02897-9","article-title":"Chemotherapy-related cardiac dysfunction: the usefulness of myocardial work indices","volume":"39","author":"Di Lisi","year":"2023","journal-title":"Int J Cardiovasc Imaging"},{"key":"2025070708270840000_pvaf028-B11","doi-asserted-by":"publisher","first-page":"7127","DOI":"10.3390\/jcm12227127","article-title":"Atrial strain assessment for the early detection of cancer therapy-related cardiac dysfunction in breast cancer women (the STRANO STUDY: atrial strain in cardio-oncology)","volume":"12","author":"Di Lisi","year":"2023","journal-title":"J Clin Med"},{"key":"2025070708270840000_pvaf028-B12","doi-asserted-by":"publisher","first-page":"2027","DOI":"10.34067\/KID.0002772021","article-title":"SGLT2 inhibitors: physiology and pharmacology","volume":"2","author":"Wright","year":"2021","journal-title":"Kidney360"},{"key":"2025070708270840000_pvaf028-B13","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1016\/j.jacbts.2020.02.004","article-title":"Mechanisms of cardiovascular benefits of sodium glucose co-transporter 2 (SGLT2) inhibitors: a state-of-the-art review","volume":"5","author":"Lopaschuk","year":"2020","journal-title":"JACC Basic Transl Sci"},{"key":"2025070708270840000_pvaf028-B14","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1016\/S0140-6736(22)01429-5","article-title":"SGLT2 inhibitors in patients with heart failure: a comprehensive meta-analysis of five randomised controlled trials","volume":"400","author":"Vaduganathan","year":"2022","journal-title":"Lancet"},{"key":"2025070708270840000_pvaf028-B15","doi-asserted-by":"publisher","first-page":"1284","DOI":"10.1161\/CIRCULATIONAHA.121.056824","article-title":"Effect of empagliflozin on worsening heart failure events in patients with heart failure and preserved ejection fraction: EMPEROR-preserved trial","volume":"144","author":"Packer","year":"2021","journal-title":"Circulation"},{"key":"2025070708270840000_pvaf028-B16","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s40959-024-00260-y","article-title":"Use of EMPAgliflozin in the prevention of CARDiotoxicity: the EMPACARD\u2014PILOT trial","volume":"10","author":"Daniele","year":"2024","journal-title":"Cardio-Oncol. Lond. Engl"},{"key":"2025070708270840000_pvaf028-B17","doi-asserted-by":"publisher","first-page":"6107","DOI":"10.1007\/s00210-024-03021-x","article-title":"Exploring the therapeutic potential of SGLT2 inhibitors in cancer treatment: integrating in silico and in vitro investigations","volume":"397","author":"Mohite","year":"2024","journal-title":"Naunyn. Schmiedebergs Arch. Pharmacol"},{"key":"2025070708270840000_pvaf028-B18","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.jaccao.2024.01.007","article-title":"The cardioprotective and anticancer effects of SGLT2 inhibitors","volume":"6","author":"Dabour","year":"2024","journal-title":"JACC CardioOncol"},{"key":"2025070708270840000_pvaf028-B19","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae666.3164","article-title":"Effects of SGLT2 inhibitors on the cardiovascular outcomes in patients with cancer: a systematic review and meta-analysis","volume":"45","author":"Liu","year":"2024","journal-title":"Eur Heart J"},{"key":"2025070708270840000_pvaf028-B20","doi-asserted-by":"publisher","first-page":"e1003583","DOI":"10.1371\/journal.pmed.1003583","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"18","author":"Page","year":"2021","journal-title":"PLoS Med"},{"key":"2025070708270840000_pvaf028-B21","doi-asserted-by":"publisher","first-page":"e0274519","DOI":"10.1371\/journal.pone.0274519","article-title":"Sodium-glucose cotransporter 2 (SGLT2) inhibitor initiation and hepatocellular carcinoma prognosis","volume":"17","author":"Hendryx","year":"2022","journal-title":"PLoS One"},{"key":"2025070708270840000_pvaf028-B22","doi-asserted-by":"publisher","first-page":"1541","DOI":"10.1038\/s41416-023-02177-2","article-title":"Sodium-glucose cotransporter 2 (SGLT2) inhibitors and non-small cell lung cancer survival","volume":"128","author":"Luo","year":"2023","journal-title":"Br J Cancer"},{"key":"2025070708270840000_pvaf028-B23","doi-asserted-by":"publisher","first-page":"101500","DOI":"10.1016\/j.diabet.2023.101500","article-title":"Effects of SGLT2 inhibitors on clinical cancer survival in patients with type 2 diabetes","volume":"50","author":"Huang","year":"2024","journal-title":"Diabetes Metab"},{"key":"2025070708270840000_pvaf028-B24","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1016\/j.jaccao.2024.08.001","article-title":"SGLT2i and primary prevention of cancer therapy-related cardiac dysfunction in patients with diabetes","volume":"6","author":"Bhatti","year":"2024","journal-title":"JACC CardioOncol"},{"key":"2025070708270840000_pvaf028-B25","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/j.amjcard.2024.04.032","article-title":"Cardioprotective potential of sodium-glucose cotransporter-2 inhibitors in patients with cancer treated with anthracyclines: an observational study","volume":"222","author":"Fath","year":"2024","journal-title":"Am J Cardiol"},{"key":"2025070708270840000_pvaf028-B26","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1016\/j.jaccao.2023.03.011","article-title":"The association of sodium-glucose cotransporter 2 inhibitors with cardiovascular outcomes in anthracycline-treated patients with cancer","volume":"5","author":"Abdel-Qadir","year":"2023","journal-title":"JACC CardioOncol"},{"key":"2025070708270840000_pvaf028-B27","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"2025070708270840000_pvaf028-B28","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1016\/j.jchf.2022.03.006","article-title":"Sodium-glucose co-transporter-2 inhibitors and cardiac outcomes among patients treated with anthracyclines","volume":"10","author":"Gongora","year":"2022","journal-title":"JACC Heart Fail"},{"key":"2025070708270840000_pvaf028-B29","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1136\/heartjnl-2022-321545","article-title":"Impact of sodium-glucose cotransporter-2 inhibitors on heart failure and mortality in patients with cancer","volume":"109","author":"Chiang","year":"2023","journal-title":"Heart"},{"key":"2025070708270840000_pvaf028-B30","doi-asserted-by":"publisher","first-page":"21756","DOI":"10.1038\/s41598-023-48678-1","article-title":"Sodium-glucose cotransporter-2 inhibitors improve clinical outcomes in patients with type 2 diabetes Mellitus undergoing anthracycline-containing chemotherapy: an emulated target trial using nationwide cohort data in South Korea","volume":"13","author":"Hwang","year":"2023","journal-title":"Sci Rep"},{"key":"2025070708270840000_pvaf028-B31","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.jchf.2023.08.026","article-title":"SGLT2 inhibitor use and risk of clinical events in patients with cancer therapy\u2013related cardiac dysfunction","volume":"12","author":"Avula","year":"2024","journal-title":"JACC Heart Fail"},{"key":"2025070708270840000_pvaf028-B32","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/s40959-023-00199-6","article-title":"Sodium-glucose co-transporter-2 inhibitors in patients treated with immune checkpoint inhibitors","volume":"10","author":"Perelman","year":"2024","journal-title":"Cardio-Oncol"},{"key":"2025070708270840000_pvaf028-B33","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1186\/s13098-024-01354-4","article-title":"Cardiovascular outcomes associated with SGLT2 inhibitor therapy in patients with type 2 diabetes Mellitus and cancer: a systematic review and meta-analysis","volume":"16","author":"Kuo","year":"2024","journal-title":"Diabetol Metab Syndr"},{"key":"2025070708270840000_pvaf028-B34","doi-asserted-by":"publisher","first-page":"2117","DOI":"10.1056\/NEJMoa1504720","article-title":"Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes","volume":"373","author":"Zinman","year":"2015","journal-title":"N Engl J Med"},{"key":"2025070708270840000_pvaf028-B35","doi-asserted-by":"publisher","first-page":"644","DOI":"10.1056\/NEJMoa1611925","article-title":"Canagliflozin and cardiovascular and renal events in type 2 diabetes","volume":"377","author":"Neal","year":"2017","journal-title":"N Engl J Med"},{"key":"2025070708270840000_pvaf028-B36","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1056\/NEJMoa1812389","article-title":"Dapagliflozin and cardiovascular outcomes in type 2 diabetes","volume":"380","author":"Wiviott","year":"2019","journal-title":"N Engl J Med"},{"key":"2025070708270840000_pvaf028-B37","doi-asserted-by":"publisher","DOI":"10.1111\/eci.14392","article-title":"Sodium-glucose cotransporter 2 inhibitors and outcomes in transthyretin amyloid cardiomyopathy: systematic review and meta-analysis","author":"Karakasis","year":"2025","journal-title":"Eur J Clin Invest"},{"key":"2025070708270840000_pvaf028-B38","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1016\/j.neo.2021.02.003","article-title":"Perturbations of cancer cell metabolism by the antidiabetic drug canagliflozin","volume":"23","author":"Papadopoli","year":"2021","journal-title":"Neoplasia"},{"key":"2025070708270840000_pvaf028-B39","doi-asserted-by":"publisher","first-page":"110821","DOI":"10.1016\/j.biopha.2020.110821","article-title":"Sodium-glucose co-transporter-2 (SGLT-2) inhibition reduces glucose uptake to induce breast cancer cell growth arrest through AMPK\/mTOR pathway","volume":"132","author":"Zhou","year":"2020","journal-title":"Biomed Pharmacother"},{"key":"2025070708270840000_pvaf028-B40","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1016\/j.jacc.2023.10.030","article-title":"Hyperuricemia and gout reduction by SGLT2 inhibitors in diabetes and heart failure","volume":"83","author":"Packer","year":"2024","journal-title":"J Am Coll Cardiol"},{"key":"2025070708270840000_pvaf028-B41","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1007\/s00395-024-01059-9","article-title":"Sodium\u2013glucose cotransporter 2 inhibitors and the cancer patient: from diabetes to cardioprotection and beyond","volume":"120","author":"Camilli","year":"2024","journal-title":"Basic Res Cardiol"}],"container-title":["European Heart Journal - Cardiovascular Pharmacotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcvp\/advance-article-pdf\/doi\/10.1093\/ehjcvp\/pvaf028\/63002646\/pvaf028.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcvp\/article-pdf\/11\/4\/343\/63002646\/pvaf028.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcvp\/article-pdf\/11\/4\/343\/63002646\/pvaf028.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T08:27:11Z","timestamp":1751876831000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcvp\/article\/11\/4\/343\/8119361"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,25]]},"references-count":41,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,25]]},"published-print":{"date-parts":[[2025,7,7]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcvp\/pvaf028","relation":{},"ISSN":["2055-6837","2055-6845"],"issn-type":[{"value":"2055-6837","type":"print"},{"value":"2055-6845","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,7]]},"published":{"date-parts":[[2025,4,25]]}}}