SGLT2 inhibitors are associated with reductions in epicardial adipose tissue volume and thickness: a meta-analysis
Abstract
Background: Epicardial adipose tissue (EAT), a metabolically active fat depot surrounding the myocardium, is implicated in the pathogenesis of cardiovascular disease. Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have demonstrated cardioprotective effects beyond glucose lowering, including a modification of EAT. We performed a systematic review and meta-analysis to evaluate the effect of SGLT2i on serial EAT measurement.
Methods: A comprehensive search of PubMed, Medline, EMBASE, Cochrane Library and grey literature (English only, 2000-2025) was performed for studies assessing EAT pre- and post-SGLT2i treatment, or SGLT2i vs conventional therapy, using computed tomography, echocardiography, or cardiac magnetic resonance. Data were meta-analysed using random-effects models with standardised mean differences (SMD) as summary effects.
Results: A total of 11 studies, including 284 patients, were included (89 with echocardiographic EAT thickness assessment and 195 with volumetric measurement using CT or CMR). In analyses comparing SGLT2 inhibitors with conventional antidiabetic therapy, treatment was associated with a significant reduction in EAT (Hedges g - 1.64, 95% CI -2.10 to -1.18; p < 0.01). In exploratory within-group analyses, SGLT2 inhibitor therapy was associated with a reduction in EAT from baseline to follow-up (Hedges g - 0.62, 95% CI -0.88 to -0.36; p < 0.01). On modality-specific subgroup analysis, reductions were observed in both EAT thickness…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 284 participants or records.
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