Dapagliflozin outperforms metformin in heart protection after infarction, study finds

A new study has compared the effects of dapagliflozin and metformin in protecting the heart after a myocardial infarction in diabetic patients. Published in BMC Pharmacology and Toxicology, the research highlights dapagliflozin's stronger ability to reduce damage and improve heart function. Scientists now call for further clinical trials to confirm its potential as a first-choice treatment for diabetic heart disease.

The study used diabetic rodent models to mimic human heart injury caused by reduced blood flow. Rats treated with dapagliflozin showed smaller areas of dead tissue and less expansion of the heart's ventricles. Their heart function also remained closer to normal compared to those given metformin.

Dapagliflozin worked through several mechanisms. It lowered oxidative stress and controlled inflammation more effectively than metformin. It also improved how heart muscle cells handled calcium, making their contractions more efficient. Previous large-scale trials have already supported dapagliflozin's benefits. The DAPA-HF trial (2019) found it reduced the risk of worsening heart failure or cardiovascular death in patients with and without diabetes. DECLARE-TIMI 58 (2018) confirmed its safety and kidney benefits for type 2 diabetes, while DAPA-CKD (2020) showed protection for both heart and kidneys in chronic kidney disease. These findings led to recommendations in major guidelines, including the ESC 2021 Heart Failure and ADA Standards of Care, which now list SGLT2 inhibitors like dapagliflozin as a first-line option for high-risk patients. Despite these advances, researchers stress the need for more studies. Key questions remain about long-term effects, the best dosages, and whether combining dapagliflozin with metformin could offer even greater protection.

The findings position dapagliflozin as a promising treatment for diabetic patients with heart disease. Its ability to reduce infarct size, improve calcium handling, and lower inflammation sets it apart from metformin. However, further human trials are required before it can become a standard therapy in clinical practice.