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Published on: April 17, 2021
Factors affecting the efficacy of SGLT2is on heart failure events: a meta-analysis based on cardiovascular outcome
Mei Qiu1, Liang-Liang Ding2, Hai-Rong Zhou1
1Department of General Medicine, Shenzhen Longhua District Central Hospital, Shenzhen, China.
Background:
The efficacy of sodium-glucose transporter 2 inhibitors (SGLT2is) on heart failure outcomes is unestablished in various subgroups defined by clinically important factors. We intended to evaluate the effects of six important factors on the efficacy of SGLT2is on heart failure outcomes.
Methods:
We included cardiovascular outcome trials (CVOTs) concerning SGLT2is. We assessed the heart failure composite outcome of cardiovascular death (CVD) or hospitalization for heart failure (HHF). Meta-analysis was conducted stratified by the following 6 factors: type of underlying diseases, type of SGLT2is, left ventricular ejection fraction (LVEF) level, New York Heart Association (NYHA) class, region, and race.
Results:
Ten CVOTs were included. Compared with placebo, SGLT2is reduced heart failure composite outcome by 25% [hazard ratio (HR) 0.75, 95% confidence interval (CI), 0.72-0.78] independent of type of underlying diseases, type of SGLT2is, LVEF level, and region (Psubgroup: 0.673, 0.244, 0.429, and 0.127, respectively). SGLT2is led to greater reduction in the composite outcome in patients with NYHA class II (HR 0.66, 95% CI, 0.59-0.74) than in patients with NYHA class III or IV (HR 0.86, 95% CI, 0.75-0.99; Psubgroup=0.004), and in Black (HR 0.63, 95% CI, 0.49-0.82) and Asian (HR 0.64, 95% CI, 0.53-0.77) patients than in White patients (HR 0.81, 95% CI, 0.76-0.86; Psubgroup=0.016).
Conclusions:
SGLT2is reduce heart failure composite outcome by 25% independent of type of underlying diseases, type of SGLT2is, LVEF level, and region. SGLT2is lead to greater reduction in the composite outcome in patients with NYHA class II than in patients with NYHA class III or IV, and in Black and Asian patients than in White patients.
Keywords:
Sodium-glucose transporter 2 inhibitors (SGLT2is); heart failure; chronic kidney disease (CKD); type 2 diabetes.
Insights
Sodium-glucose transporter 2 inhibitors (SGLT2is) significantly reduce heart failure events by 25% across diverse patient groups. The drug
Area of Science:
- Cardiology
- Pharmacology
- Metabolic Diseases
Background:
- Efficacy of SGLT2 inhibitors (SGLT2is) in heart failure (HF) subgroups remains unclear.
- Key clinical factors influencing SGLT2is' HF outcomes require investigation.
Purpose of the Study:
- To evaluate the impact of six factors on SGLT2is' efficacy in HF.
- To analyze HF composite outcomes (cardiovascular death or HF hospitalization).
Main Methods:
- Meta-analysis of 10 cardiovascular outcome trials (CVOTs) involving SGLT2is.
- Stratified analysis based on underlying disease, SGLT2i type, LVEF, NYHA class, region, and race.
Main Results:
- SGLT2is reduced HF composite outcomes by 25% (HR 0.75) irrespective of disease type, SGLT2i, LVEF, or region.
- Greater benefits observed in NYHA class II patients vs. III/IV.
- Enhanced efficacy noted in Black and Asian patients compared to White patients.
Conclusions:
- SGLT2is demonstrate consistent efficacy in reducing HF composite outcomes across various subgroups.
- NYHA class and race significantly modify SGLT2is' effectiveness in HF management.
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