SLC5A2 and hydrops fetalis: New recommendations guided by CVOTs include an early consideration of CV risk and preference for an agent with proven CV benefit as a first-add on to metformin in an atherosclerotic CVD setting (preferring empagliflozin or liraglutide) [1–3, 6] or an SGLT2 inhibitor as a first add-on to metformin in a HF setting [1–3, 5] (Fig. 1).