The blood pressure-lowering effect could be a driver of
the vascular protection noted, with blood pressure lowering
consistently shown to prevent cardiovascular events in
patients with diabetes.79 Typically, however, greater benefits
have been noted for stroke than for myocardial infarction,
and the apparently adverse eff ect of SGLT2 inhibition on
non-fatal stroke is therefore surprising. No clear evidence
exists that glucose lowering or weight loss increased stroke
risk, although haemoconcentration caused by inhibition of
SGLT2 has been postulated to increase the risk of arterial
thrombosis. The apparently larger benefit for cardiovascular
death than for myocardial infarction or stroke
suggests that other mechanisms might also be important,
and the heart failure effect could provide a clue.