SGLT2 inhibition modifies a variety of cardiovascular risk factors but the observed CV endpoint data of empagliflozin use in the EMPA REG study far exceeded expectations.  This has prompted intense interest in the potential mechanisms involved , particularly the non –glycaemic effects, and debate over whether these benefits are likely to be class effect. The available CV effects of SGLT2 inhibitors will be reviewed and potential mechanisms investigated. The potential ramifications of these CV effects, particularly if confirmed in other cardiovascular outcome trials ,on cardiology and endocrine practise will also be explored.