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Heart failure hospitalization with SGLT-2 inhibitors: a systematic review and meta-analysis of randomized controlled

Awadhesh Kumar Singh1, Ritu Singh2

  • 1a Department of Endocrinology , GD Hospital & Diabetes Institute , Kolkata , India.

Expert Review of Clinical Pharmacology
|March 1, 2019
PubMed

Insights

Sodium-glucose linked co-transporter 2 inhibitors (SGLT-2Is) significantly reduce heart failure hospitalizations in type 2 diabetes mellitus (T2DM). This meta-analysis confirms SGLT-2Is benefit patients with and without established heart failure.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Type 2 diabetes mellitus (T2DM) significantly increases mortality risk in patients with heart failure (HF).
  • Traditional anti-diabetic drugs have not demonstrated a reduction in HF hospitalizations (hHF).
  • Some anti-diabetic classes, like thiazolidinediones and saxagliptin, are associated with increased hHF risk.

Purpose of the Study:

  • To systematically evaluate the effect of sodium-glucose linked co-transporter 2 inhibitors (SGLT-2Is) on heart failure hospitalizations (hHF) in patients with T2DM.
  • To conduct a meta-analysis of randomized controlled trials (RCTs) and observational studies assessing SGLT-2Is' impact on hHF.

Main Methods:

  • Systematic literature search of PubMed, Embase, ClinicalTrials.gov, and conference presentations up to December 25, 2018.
  • Inclusion of studies with a duration of ≥24 weeks that explicitly reported hHF outcomes.
  • Meta-analysis performed on RCTs, observational studies, and a combined cohort.

Main Results:

  • Meta-analysis of RCTs (N=34,322) showed a significant reduction in hHF with SGLT-2Is (OR 0.70, p=0.000).
  • Observational studies (N=15,36,339) and combined analysis (N=15,70,661) also demonstrated significant hHF reduction (OR 0.64, p=0.000 and OR 0.66, p=0.000, respectively).
  • Subgroup analysis of RCTs in patients with established HF (N=3891) revealed a significant benefit (OR 0.68, p=0.000).

Conclusions:

  • SGLT-2 inhibitors represent a significant therapeutic advancement in reducing heart failure hospitalizations for patients with type 2 diabetes mellitus.
  • The benefits extend to patients with pre-existing heart failure, irrespective of ejection fraction.
  • Further dedicated heart failure trials are anticipated to further clarify the role of SGLT-2Is in diverse HF populations.
Abstract

Keywords:
SGLT-2 inhibitorsType 2 diabetescardiovascular outcomeheart failure hospitalization

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