Effect of SGLT-2 inhibitors on cardiovascular outcomes in heart failure patients: A meta-analysis of randomized controlled trials |
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| Affiliation: | 1. Department of Cardiology, Xuzhou Medical College Affiliated Hospital, Xuzhou, 221006, China;2. Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing 100034, China;3. Department of Endocrinology, Xuzhou Medical College Affiliated Hospital, Xuzhou, 221006, China;1. Department of General Medicine, Shenzhen Longhua District Central Hospital, Shenzhen 518110, China;2. Department of Endocrinology, First Affiliated Hospital of Yangtze University, Jingzhou 434000, China;3. Class 3, Clinical medicine, Grade 2019, The Second Clinical Medical College, Southern Medical University, China;1. Service d''Ophtalmologie. Hôpital Robert Debré. Centre Hospitalier Universitaire Reims. France;2. Service de Rhumatologie. Hôpital Maison Blanche. Centre Hospitalier Universitaire Reims. France;3. Service de Médecine Interne, Maladies Infectieuses et Immunologie Clinique. Hôpital Robert Debré. Centre Hospitalier Universitaire Reims. France;1. Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital “Hippokration”, Greece;2. Third Department of Cardiology, Aristotle University of Thessaloniki, General Hospital “Hippokration”, Greece;3. Veterans Affairs Medical Center, George Washington University, Washington, District of Columbia;1. Division of Hospital Medicine, University of Kentucky, Lexington, Kentucky;2. Department of Internal Medicine, University of Toledo, Toledo, Ohio;3. Department of Cardiology, University of Connecticut, Framingham, Connecticut;4. Department of Cardiology, Creighton University, Omaha, Nebraska;5. Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky;1. Department of Internal Medicine, HCA Healthcare/USF Morsani GME Consortium: HCA Florida Citrus Hospital, Inverness, FL, USA;2. Department of Internal Medicine, University of Florida-Jacksonville, Jacksonville, FL, USA;3. Research Methodology and Biostatistics Core, Office of Research, Department of Internal Medicine, University of South Florida, Tampa, FL, USA;4. Department of Cardiovascular Sciences, University of South Florida, Tampa, FL, USA;5. Citrus Cardiology, Inverness, FL, USA |
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| Abstract: | BackgroundTo investigate the overall effect of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) on cardiovascular outcomes in a broad spectrum of heart failure (HF) patients, and further stratified by status of ejection fraction and diabetes mellitus.MethodsElectronic databases were searched to identify randomized controlled trials that compared SGLT-2i with placebo in patients with HF. Efficacy outcomes included the composite of cardiovascular death (CVD) or hospitalization for heart failure (HHF), individual CVD, individual HHF, and all-cause mortality (ACM).ResultsA total of 8 large trials comprising 16,460 HF patients were enrolled. Pooled data demonstrated that SGLT-2i significantly reduced the risk for primary composite outcome (CVD or HHF) by 23% (HR: 0.77, 95% CI: 0.72–0.82) in HF patients. Use of SGLT-2i was associated with a statistically significant 32% reduction in HHF (HR: 0.68, 95% CI: 0.62–0.75), a 15% reduction in CVD (HR: 0.85, 95% CI: 0.76–0.94) and a 16% reduction in ACM (HR: 0.84, 95% CI: 0.77–0.92). Sensitivity analyses using Mantel-Haenszel method displayed consistent results. Subgroup analyses demonstrated that SGLT-2i were robustly effective in HFrEF subgroup as well as in HF with absence/presence of T2DM, and displayed a strong trend to be effective in HFpEF. Safety analysis demonstrated SGLT-2i group had a lower proportion of serious adverse events than placebo group (RR 0.89, 95% CI: 0.86–0.93).ConclusionsCompared with placebo, SGLT-2 inhibitors have remarkable cardiovascular benefits in a broad range of HF patients. Beneficial effects were robust in HF patients regardless of T2DM status, and a strong trend to be effective in HFpEF. |
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