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Glucose-lowering Drugs and Hospitalization for Heart Failure: A Systematic Review and Additive-effects Network
Riobaldo M Cintra1, Ana Claudia Nogueira2, Isabella Bonilha1
1Atherosclerosis and Vascular Biology Laboratory (Atherolab), Cardiology Department, State University of Campinas (Unicamp), Campinas, SP, Brazil.
The Journal of Clinical Endocrinology and Metabolism
|June 14, 2021
Summary
Sodium glucose co-transporter 2 inhibitors (SGLT2is) reduce heart failure hospitalization risk, while thiazolidinediones (TZDs) increase it. Glucose lowering consistently reduces heart failure risk across therapies.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Pharmacology
Background:
- Sodium glucose co-transporter 2 inhibitors (SGLT2is) are known to prevent heart failure hospitalization (HHF).
- Patients with type 2 diabetes mellitus often use multiple antihyperglycemic drugs, complicating the prediction of HHF risk and glucose-lowering effects.
- The impact of various antihyperglycemic drug combinations on HHF risk remains unclear.
Purpose of the Study:
- To investigate the influence of different antihyperglycemic drugs and their combinations on the risk of heart failure hospitalization (HHF).
- To analyze the association between glucose-lowering efficacy and HHF risk across various diabetes medications.
Main Methods:
- A random additive-effects network meta-analysis was conducted.
- Data were sourced from forty randomized controlled trials (RCTs) reporting on heart failure hospitalization (HHF).
- Incidence rates of HHF were extracted and analyzed.
Main Results:
- Metformin, sulfonylureas, glucagon-like peptide-1 receptor-agonists, and dipeptidyl peptidase 4 inhibitors (DPP4is) showed neutral effects on HHF risk.
- SGLT2is, as monotherapy or combined with DPP4is, significantly reduced HHF risk (HR: 0.68-0.70).
- Thiazolidinediones (TZDs), alone or with DPP4is, increased HHF risk (HR: 1.45-1.49).
- A 1% reduction in HbA1c was associated with a 31.3% decrease in HHF risk, irrespective of therapy.
Conclusions:
- SGLT2is effectively reduce HHF risk, whether used alone or with DPP4is.
- TZDs are associated with an increased risk of HHF, particularly in monotherapy or combination regimens.
- Achieving glucose-lowering targets contributes additively to reducing HHF risk.
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