Background Until recently, there are no available preventive measures for macrovascular complications of diabetes mellitus (DM). Sodium-glucose co-transporter inhibitors (SGLT-2i) are a relatively new class of medications with cardio-renal protection. However, it is unknown, whether this is a class effect. Also, the exact mechanisms of action are not fully understood. Aims The current review aimed to assess dapagliflozin effects on the major cardiovascular adverse events (MACE) and heart failure hospitalization rate (HHF) and its mechanisms of action. 3. What are the implications for research, policy, or practice? Dapagliflozin can be used safely among patients with both systolic and diastolic HF even among patients with prediabetes or normal sugar profile in particular for patients with bumetanide due to its favourable effects on hyperuricemia. Dapagliflozin is superior to empagliflozin (the first SGLT-2i to show CV benefits especially mortality) for HHF reduction.

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