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On one hand, the cardiovascular protection afforded by SGLT2is seems to result from their beneficial hemodynamic effects, including improvement in ventricular preload (secondary to natriuresis and osmotic diuresis) and afterload (through blood pressure reduction), but also from improvement of cardiac metabolism (through the switch from utilization of glucose to ketones), inhibition of the myocardial Na + /H + exchanger, reduction of cardiac fibrosis and necrosis, reduction of proinflammatory adipokines derived from epicardial and perivascular fat, and stimulation of erythropoiesis (which can facilitate the release of oxygen to ischemic tissues) [1, 4, 14,15,16]
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They can also worsen physical tension, irritability, or insomnia in some patients
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