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SGLT2i versus ARNI in heart failure with reduced ejection fraction: a systematic review and meta-analysis

Yuling Yan1, Bin Liu1, Jun Du1

  • 1Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74, Linjiang Road, Yuzhong District, Chongqing, 400010, China.

ESC Heart Failure
|March 22, 2021
PubMed

Insights

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) effectively reduce cardiovascular events in heart failure with reduced ejection fraction (HFrEF). Combination therapy with angiotensin receptor neprilysin inhibitors (ARNI) offers superior protection compared to monotherapy.

Area of Science:

  • Cardiology
  • Pharmacology
  • Internal Medicine

Background:

  • Heart failure with reduced ejection fraction (HFrEF) remains a significant cause of cardiovascular morbidity and mortality.
  • Current therapeutic strategies aim to reduce hospitalizations and improve survival in HFrEF patients.

Purpose of the Study:

  • To evaluate the efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in HFrEF.
  • To compare SGLT2i with angiotensin receptor neprilysin inhibitors (ARNI).
  • To assess the benefit of combining SGLT2i and ARNI versus monotherapy in HFrEF.

Main Methods:

  • A systematic review and indirect treatment comparison of randomized controlled trials (RCTs) were conducted.
  • Databases searched include Embase, Medline, and Cochrane Central Registry of Controlled Trials.
  • Six trials evaluating SGLT2i or ARNI in HFrEF were included in the analysis.

Main Results:

  • SGLT2i significantly reduced the risk of cardiovascular death or hospitalization for heart failure by 27% (HR 0.73) and all-cause death by 16% (HR 0.84).
  • Benefits of SGLT2i were consistent in patients with and without diabetes mellitus.
  • SGLT2i and ARNI showed similar effects on the primary outcome, but their combination demonstrated superior prognosis (HR 0.68).

Conclusions:

  • SGLT2i provides a safe and effective means to reduce cardiovascular events in HFrEF, irrespective of diabetes status.
  • Both SGLT2i and ARNI are effective, but combination therapy yields enhanced cardiovascular protection.
  • Combination therapy of SGLT2i and ARNI represents a promising strategy for managing HFrEF.
Abstract

Keywords:
Angiotensin receptor neprilysin inhibitorHeart failure with reduced ejection fractionMeta-analysisSodium-glucose cotransporter-2 inhibitor

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