Sodium–glucose cotransporter 2 inhibitors (SGLT2i), a new drug class initially designed
and approved for treatment of diabetes mellitus, have been shown to exert pleiotropic
metabolic and direct cardioprotective and nephroprotective effects that extend beyond
their glucose-lowering action. These properties prompted their use in two frequently
intertwined conditions, heart failure and chronic kidney disease. Their unique mechanism
of action makes SGLT2i an attractive option also to lower the rate of cardiac events
and improve overall survival of oncological patients with preexisting cardiovascular
risk and/or candidate to receive cardiotoxic therapies. This review will cover biological
foundations and clinical evidence for SGLT2i modulating myocardial function and metabolism,
with a focus on their possible use as cardioprotective agents in the cardio-oncology
settings. Furthermore, we will explore recently emerged SGLT2i effects on hematopoiesis
and immune system, carrying the potential of attenuating tumor growth and chemotherapy-induced
cytopenias.
