Patients with peripheral artery disease (PAD) remain at particularly high risk for heart failure, cardiovascular death, and kidney complications, although evidence supporting sodium-glucose cotransporter-2 inhibitors (SGLT2i) in this population has remained limited. A systematic review and meta-analysis published in Cardiovascular Diabetology evaluated whether SGLT2i therapy is associated with improved cardiovascular, renal, and limb outcomes in patients with PAD.

The analysis included five studies comprising 7,275 patients with PAD identified through searches of PubMed, Embase, and the Cochrane Library through December 20, 2025. The primary endpoint was the composite of hospitalization for heart failure (HHF) or cardiovascular death, while secondary outcomes included HHF, cardiovascular death, amputation, adverse renal outcomes, all-cause mortality, and major adverse cardiovascular events (MACE).

Findings

• SGLT2i therapy was associated with a lower risk of the composite of HHF or cardiovascular death (HR 0.73; 95% CI, 0.64-0.83; p < 0.001).
• A lower incidence of HHF was observed with SGLT2i therapy (HR 0.63; 95% CI, 0.51-0.77; p < 0.001).
• Cardiovascular death risk was lower among patients receiving SGLT2i therapy (HR 0.83; 95% CI, 0.69-1.00; p = 0.045).
• SGLT2i therapy was also associated with lower risk of adverse renal outcomes (HR 0.74; 95% CI, 0.55-0.98; p = 0.038).
• No significant increase in amputation risk was observed (HR 1.17; 95% CI, 0.87-1.56; p = 0.293).
• No significant reductions were observed for all-cause mortality (HR 0.86; 95% CI, 0.69-1.08; p = 0.192) or MACE (HR 0.89; 95% CI, 0.75-1.06; p = 0.207).

These findings suggest SGLT2i therapy may provide cardiovascular and renal benefit in patients with PAD without increasing amputation risk, although no significant reductions were observed in MACE or all-cause mortality.