What is known about SGLT2 drugs and aging?

SGLT2 drugs lower the risk of heart death and heart failure hospital stays, including in older adults with heart failure or diabetes. Whether they slow aging itself is unknown.

Who it's for

Older adults with heart failure or type 2 diabetes; not shown to help healthy people.

What to expect

About 20% fewer heart deaths or heart failure admissions in heart failure; no proven anti-aging effect.

Watch out for

Genital infections and low blood pressure; weight loss may include some muscle.

What the studies show

• A review that pooled 5 trials of 21,947 people with heart failure found SGLT2 drugs lowered the risk of heart death or hospital stays for heart failure by about 23% compared with a dummy pill (placeboplacebo A dummy treatment that looks like the real one, so people can't tell which they got.). The benefit held across ejection fraction (how well the heart pumps)3Meta-analysis · 2022 · 947 peopleSGLT-2 inhibitors in patients with heart failure: a comprehensive meta-analysis of five randomised controlled trials.SGLT2 inhibitors reduced the risk of cardiovascular death and hospitalisations for heart failure in a broad range of patients with heart failure, supporting their role as a foundational therapy for heart failure, irrespective of ejection fraction or care setting.Lancet.
• A review that pooled 11 trials of 78,607 people with diabetes, heart failure or kidney disease found a 9% lower relative riskrelative risk How much more or less likely something is in one group than another, as a ratio. A big relative change can still be a small change for any one person. of major heart events. This came mainly from fewer heart deaths. There was no clear effect on stroke, and the heart attack result could be down to chance4Meta-analysis · 2024 · 607 peopleSodium-Glucose Cotransporter-2 Inhibitors and Major Adverse Cardiovascular Outcomes: A SMART-C Collaborative Meta-Analysis.SGLT2i reduce the risk of MACE across a broad range of patients irrespective of atherosclerotic cardiovascular disease, diabetes, kidney function, or other major clinical characteristics at baseline. This effect is driven primarily by a reduction of cardiovascular death, particularly HF death and sudden cardiac death,…Circulation. These figures compare groups, so one person's gain depends on their starting risk.
• In older or frail people with diabetes and heart failure, a review of 20 studies (77,083 people) linked SGLT2 drugs to 19% lower risk of death from any cause. Blood sugar did not fall significantly2Meta-analysis · 2024 · 77,083 peopleSodium-glucose cotransporter-2 inhibitors (SGLT2) in frail or older people with type 2 diabetes and heart failure: a systematic review and meta-analysis.In older or frail patients with T2D and HF, SGLT2Is are consistently linked with a decrease in total mortality and the overall burden of cardiovascular (CV) events, including HHF events and cardiac death, but not protective for macrovascular death or renal events. Adverse events were more difficult to quantify but the…Age Ageing. A network analysis found heart protection was larger with older age even though sugar lowering was smaller1Meta-analysis · 2025 · 503 peopleAge and Sex Differences in Efficacy of Treatments for Type 2 Diabetes: A Network Meta-Analysis.The SGLT2 inhibitors and GLP-1 receptor agonists were associated with lower risk of MACEs. Analysis of age × treatment interactions suggested that SGLT2 inhibitors were more cardioprotective in older than in younger people despite smaller reductions in HbA1c; GLP-1 receptor agonists were more cardioprotective in…JAMA.
• Age did not change the benefit of dapagliflozin in two large trials of heart failure: DAPA-HF (4,744 people, ages 22 to 94)6Randomized trial · 2020 · 4,744 peopleEfficacy and Safety of Dapagliflozin in Heart Failure With Reduced Ejection Fraction According to Age: Insights From DAPA-HF.Dapagliflozin reduced the risk of death and worsening heart failure and improved symptoms across the broad spectrum of age studied in DAPA-HF. There was no significant imbalance in tolerability or safety events between dapagliflozin and placebo, even in elderly individuals.Circulation and DELIVER (6,263 people, average age 71.7, followed a median 2.3 years)9Randomized trial · 2022Efficacy and Safety of Dapagliflozin in Heart Failure With Mildly Reduced or Preserved Ejection Fraction According to Age: The DELIVER Trial.In patients with heart failure and mildly reduced or preserved ejection fraction enrolled in DELIVER, dapagliflozin reduced the combined risk of cardiovascular death or worsening heart failure events across the spectrum of age, with a consistent safety profile, including among the traditionally under-treated older…Circ Heart Fail. Safety was similar to placebo in all age groups, including those 75 and older.
• A trial of 1,222 older adults having a heart valve procedure found dapagliflozin 10 mg daily cut death or worsening heart failure over a year: 15.0% versus 20.1% with standard care. Genital infection and low blood pressure were more common with the drug8Randomized trial · 2025 · 1,222 peopleDapagliflozin in Patients Undergoing Transcatheter Aortic-Valve Implantation.Among older adults with aortic stenosis undergoing TAVI who were at high risk for heart-failure events, dapagliflozin resulted in a significantly lower incidence of death from any cause or worsening of heart failure than standard care alone. (Funded by Instituto de Salud Carlos III and others; ClinicalTrials.gov…N Engl J Med.
• On aging itself, one trial of 150 adults with type 2 diabetes found that henagliflozin (a related drug) 10 mg daily for 26 weeks increased telomere length (a marker of cell aging) compared with placebo10Randomized trial · 2025 · 150 peopleEffect of henagliflozin on aging biomarkers in patients with type 2 diabetes: A multicenter, randomized, double-blind, placebo-controlled study.These findings suggest that henagliflozin may exert anti-aging effects through multiple pathways. This study is registered at Chinese Clinical Trial Registry (ChiCTR2300068127).Cell Rep Med. This was a short trial in people with diabetes, and telomere length does not show longer life.

Key studies

Safety

Genital infection and low blood pressure were more common with dapagliflozin in older adults after valve replacement8Randomized trial · 2025 · 1,222 peopleDapagliflozin in Patients Undergoing Transcatheter Aortic-Valve Implantation.Among older adults with aortic stenosis undergoing TAVI who were at high risk for heart-failure events, dapagliflozin resulted in a significantly lower incidence of death from any cause or worsening of heart failure than standard care alone. (Funded by Instituto de Salud Carlos III and others; ClinicalTrials.gov…N Engl J Med. In hospitalized heart failure patients, symptomatic low blood pressure was 3.6% versus 2.2% with placebo, and worsening kidney function 5.9% versus 4.7%5Meta-analysis · 2025 · 2,401 peopleDapagliflozin in Patients Hospitalized for Heart Failure: Primary Results of the DAPA ACT HF-TIMI 68 Randomized Clinical Trial and Meta-Analysis of Sodium-Glucose Cotransporter-2 Inhibitors in Patients Hospitalized for Heart Failure.In this trial, in-hospital initiation of dapagliflozin did not significantly reduce the risk of cardiovascular death or worsening HF through 2 months in hospitalized HF patients. However, the totality of randomized clinical trial data suggests that in-hospital initiation of SGLT2 inhibitors may reduce the early risk…Circulation. Side effects rose with age but were no more common than with placebo6Randomized trial · 2020 · 4,744 peopleEfficacy and Safety of Dapagliflozin in Heart Failure With Reduced Ejection Fraction According to Age: Insights From DAPA-HF.Dapagliflozin reduced the risk of death and worsening heart failure and improved symptoms across the broad spectrum of age studied in DAPA-HF. There was no significant imbalance in tolerability or safety events between dapagliflozin and placebo, even in elderly individuals.Circulation,9Randomized trial · 2022Efficacy and Safety of Dapagliflozin in Heart Failure With Mildly Reduced or Preserved Ejection Fraction According to Age: The DELIVER Trial.In patients with heart failure and mildly reduced or preserved ejection fraction enrolled in DELIVER, dapagliflozin reduced the combined risk of cardiovascular death or worsening heart failure events across the spectrum of age, with a consistent safety profile, including among the traditionally under-treated older…Circ Heart Fail. In a year-long trial, empagliflozin cut body weight by about 2.4 kg more than placebo. Muscle mass and grip strength were not clearly changed, though the muscle estimate was uncertain7Randomized trial · 2023 · 129 peopleEfficacy and safety of the sodium-glucose co-transporter-2 inhibitor empagliflozin in elderly Japanese adults (≥65 years) with type 2 diabetes: A randomized, double-blind, placebo-controlled, 52-week clinical trial (EMPA-ELDERLY).Empagliflozin improved glucose control and reduced body weight without compromising muscle mass or strength in elderly adults with T2D in this trial.Diabetes Obes Metab. These are prescription drugs, so a clinician decides if they are appropriate.

What we don't know

• Whether SGLT2 drugs slow aging or extend healthy lifespan in people without heart failure or diabetes.
• Whether changes in aging markers such as telomere length lead to better health.