{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T04:49:23Z","timestamp":1782103763179,"version":"3.54.5"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>SGLT2 inhibitors (SGLT2i) are a cornerstone of guideline-directed therapy for heart failure (HF). However, the optimal dose for HF remains unclear, as no phase II trials have evaluated dose-response in this population. This study aimed to evaluate whether low-dose (5\u2005mg) of SGLT2i provide comparable efficacy and safety compared with the standard 10\u2005mg dose and to non-users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This nationwide retrospective cohort study utilized Korean National Health Insurance Service claims data (2013\u20132018), including 551,760 patients with HF and diabetes, of whom 55,694 were SGLT2i users. After exclusions, propensity-score matching was performed in a 5:5:1 ratio (non-users:10\u2005mg:5\u2005mg). The composite primary outcome was cardiac death, HF hospitalization, or urgent HF-related emergency department (ED) visit. Safety outcomes included ketoacidosis, acute kidney injury (AKI), urinary tract infection, and fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the matched cohort (2,637 on 5\u2005mg; 13,185 on 10\u2005mg; 13,185 non-users), the 5\u2005mg group was associated with lower risk of the primary outcome (HR: 0.73, 95% CI: 0.66\u20130.81;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) and all-cause death (HR 0.85, 95% CI 0.74\u20130.97;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.019) compared with 10\u2005mg, with similar safety profiles. Significant interactions were observed: the relative effect of 5\u2005mg vs. 10\u2005mg differed by sex and body weight for urgent ED visits, and by BMI for AKI. Sensitivity analyses across multiple time points showed consistent results, with the 5\u2005mg group associated with comparable or lower risk compared with the 10\u2005mg group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with diabetes and HF, 5\u2005mg daily SGLT2i was associated with a comparable risk to 10\u2005mg, warranting randomized dose-finding trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1859003","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T04:33:08Z","timestamp":1782102788000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of low-dose SGLT2 inhibitors in diabetic patients with heart failure: a nationwide cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Minkwan","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine","place":["Yongin, Gyeonggi-do, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seok-Jae","family":"Heo","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine","place":["Yongin, Gyeonggi-do, Republic of Korea"]},{"name":"Department of Biomedical Systems Informatics, Yonsei University College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SungA","family":"Bae","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine","place":["Yongin, Gyeonggi-do, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In Hyun","family":"Jung","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine","place":["Yongin, Gyeonggi-do, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deok-Kyu","family":"Cho","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine","place":["Yongin, Gyeonggi-do, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.1056\/NEJMoa2022190","article-title":"Cardiovascular and renal outcomes with empagliflozin in heart 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