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In Silico Clinical Trials for Cardiovascular Disease
Published on: May 27, 2022
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SGLT2 inhibitors decrease cardiovascular death and heart failure hospitalizations in patients with heart failure: A
Rhanderson Cardoso1, Fabrissio P Graffunder2, Caique M P Ternes2,3
1Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
Eclinicalmedicine
|July 26, 2021
Summary
Sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly lower mortality in heart failure (HF) patients. These drugs also reduce cardiovascular events and hospitalizations across diverse HF patient subgroups, demonstrating broad efficacy.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Sodium-glucose cotransporter 2 (SGLT2) inhibitors are known to reduce heart failure (HF) hospitalizations and cardiovascular mortality.
- However, their effectiveness in secondary trial endpoints and specific HF patient subgroups requires further investigation.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of SGLT2 inhibitors in patients with heart failure.
- To evaluate their impact on primary endpoints (all-cause and cardiovascular mortality) and secondary endpoints across various subgroups.
Main Methods:
- A systematic review and meta-analysis of placebo-controlled, randomized trials of SGLT2 inhibitors in HF patients.
- Searched PubMed, Embase, and Cochrane databases up to January 21, 2021.
- Pooled hazard ratios (HRs) for mortality endpoints, with quality assessment performed per Cochrane recommendations.
Main Results:
- Fifteen trials involving 20,241 patients were included; 10,594 received SGLT2 inhibitors.
- SGLT2 inhibitors significantly reduced all-cause mortality (HR 0.86; 95% CI 0.79-0.94) and cardiovascular mortality (HR 0.86; 95% CI 0.78-0.96).
- The composite of cardiovascular mortality, HF hospitalizations, or urgent HF visits was significantly reduced across subgroups including sex, age, race, eGFR, NYHA class, and ejection fraction.
Conclusions:
- SGLT2 inhibitors offer significant reductions in all-cause and cardiovascular mortality in heart failure patients compared to placebo.
- The benefits extend to reducing a composite of cardiovascular mortality or HF hospitalizations/urgent visits across a wide range of patient characteristics and HF classifications.
Keywords:
DM, diabetes mellitusHF, heart failureHFpEF, heart failure with preserved ejection fractionHR, hazard ratioHeart failureLVEF, left ventricular ejection fractionNYHA, New York Heart AssociationOR, odds ratioRCTs, randomized controlled trialsSGLT2 inhibitorsSGLT2, sodium-glucose cotransporter 2Type 2 Diabetescardiovascular riskeGFR, estimated glomerular filtration rate
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