ESC Congress 2026 Abstract · Oct 26, 2026
Effect of SGLT2 inhibitors on changes in skeletal muscle index in patients participating in cardiac rehabilitation
By Kanazawa M, Hatakeyama A, Takahashi H et al.
Background: Sodium / Glucose co-transporter 2 (SGLT2) inhibitors are widely used in patients with cardiovascular disease. Due to glucose and calorie loss into the urine caused by SGLT2 inhibitors, there is a potential risk of skeletal muscle loss and sarcopenia in patients taking this medicine. However, there is no evidence of those risks in patients with cardiovascular disease. Purpose: This study aimed to investigate the effect of SGLT2 inhibitors on temporal changes in skeletal muscle index (SMI) measured by bioelectrical impedance analysis in patients participating in outpatient cardiac rehabilitation programs. Methods: Forty-six patients participating in outpatient cardiac rehabilitation programs were enrolled. Patients implanted cardiac devices such as cardiac pacemakers or implantable cardioverter-defibrillator were excluded (n=6). Patients were divided into two groups: those taking SGLT2i [SGLT2i (+); n=15] and those not [SGLT2i (-); n=25]. SMI was measured at discharge and reassessed approximately four months later. Cardiopulmonary exercise testing was also performed at the same time. The changes of SMI and exercise tolerance between two points were compared. Results: In the total population, both SMI and peak VO2 showed significant improvement over the follow-up period.Both groups showed significant improvement in peak VO2 (SGLT2i (+) p=0.01, SGLT2i (-) p=0.02), but not in SMI (SGLT2i (+) p=0.14, SGLT2i (-) p=0.11). The changes of SMI (ΔSMI; SGLT2i (+) 0.30±0.90 vs. SGLT2i (-) 0.25±0.62 kg/m2, p=0.84), peak VO2 (Δpeak VO2; 1.13±2.29 vs. 1.95±2.58 ml/min/kg, p=0.30, respectively) showed no significant differences between two groups. Conclusion: SGLT2 inhibitors did not cause skeletal muscle loss or sarcopenia in patients participating in outpatient cardiac rehabilitation.ChartResults