Some of them are metabolic changes, such as more ketone body production, activation of anti-inflammatory and anti-oxidative pathways, and reduction of advanced glycation end-products mediated effects.[11–13] SGLT2 inhibitors reduces Nod-like receptor protein 3 (NLRP3) inflammasome activation, reducing IL1-β in macrophages, which is associated with less development of atherosclerotic plaques.[14] However, the efficacy and safety of SGLT2 inhibitors for the treatment of HF remains under debate. This evidence concerns the gene NLRP3 and hydrops fetalis.