Do SGLT2 inhibitors lower mortality rates in patients with transthyretin cardiomyopathy?

Transthyretin cardiomyopathy (ATTR-CM) is a progressive heart condition caused by buildup of abnormal protein. SGLT2 inhibitors are diabetes drugs that also help heart failure patients. Whether they reduce death rates in ATTR-CM is still being studied. Current research gives conflicting answers: one large study found a survival benefit, while another found no mortality reduction when SGLT2 inhibitors were added to the standard drug tafamidis.

What the research says

A 2024 study of 2,356 ATTR-CM patients compared 220 who took an SGLT2 inhibitor with 220 similar patients who did not. Over about 28 months, those on SGLT2 inhibitors had a 43% lower risk of death from any cause (hazard ratio 0.57) ⁹. The drug was well tolerated, with only 4.5% stopping it ⁹. However, a 2026 study using a large health database looked at ATTR-CM patients already taking tafamidis and added an SGLT2 inhibitor. After matching 409 patients per group, the combination did not significantly reduce death at 1 or 3 years ¹⁰. It did lower hospitalizations and heart attacks ¹⁰. These different results may be because the second study only included patients on tafamidis, while the first included many not on that drug. SGLT2 inhibitors are known to help heart failure with preserved ejection fraction, which is common in ATTR-CM ⁶, but their specific role in this rare disease is still being defined.

What to ask your doctor

• Given my ATTR-CM diagnosis, could an SGLT2 inhibitor like empagliflozin or dapagliflozin be a treatment option for me?
• If I am already taking tafamidis, would adding an SGLT2 inhibitor offer any additional benefit?
• What are the potential side effects of SGLT2 inhibitors, especially for someone with ATTR-CM?
• How would my kidney function and potassium levels be monitored if I start an SGLT2 inhibitor?
• Are there any ongoing clinical trials for SGLT2 inhibitors in ATTR-CM that I might consider?