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The Effects of Dapagliflozin in Patients With Heart Failure Complicated With Type 2 Diabetes: A Meta-Analysis of
Miaobo Zhai1, Xin Du1, Changmei Liu1
1Department of Cardiology, Affiliated Hospital of Binzhou Medical University, Binzhou, China.
Insights
Dapagliflozin significantly reduced heart failure hospitalizations and all-cause mortality in patients with type 2 diabetes and heart failure with reduced ejection fraction. However, it did not show significant cardiovascular benefits in heart failure with preserved ejection fraction.
Area of Science:
- Cardiology
- Endocrinology
- Pharmacology
Background:
- Cardiovascular disease (CVD) poses a significant threat, especially to individuals with type 2 diabetes mellitus (T2DM).
- Sodium-glucose cotransporter 2 (SGLT2) inhibitors have emerged as potential therapeutic agents for managing CVD in T2DM patients.
- Previous studies suggest SGLT2 inhibitors may reduce heart failure hospitalizations in T2DM patients.
Approach:
- A comprehensive literature search was conducted for randomized-controlled trials (RCTs) up to July 2020.
- Keywords included "sodium-glucose cotransporter-2 inhibitor", "dapagliflozin", "heart failure", "cardiovascular outcomes", "major adverse cardiovascular events", "all-cause mortality", and "cardiovascular death".
- Random-effects meta-analysis was performed to synthesize data from five trials involving 5,252 patients.
Key Points:
- Dapagliflozin significantly reduced hospitalization for heart failure (HHF) and all-cause mortality (ACM) in patients with heart failure (HF) and T2DM (HHF OR=0.74; ACM OR=0.76).
- In the subgroup of patients with heart failure with reduced ejection fraction (HFrEF), dapagliflozin demonstrated significant reductions in HHF, cardiovascular death (CVD), and ACM.
- In contrast, dapagliflozin did not show statistically significant benefits in reducing CVD or ACM in the subgroup of patients with heart failure with preserved ejection fraction (HFpEF).
Conclusions:
- Dapagliflozin effectively reduces heart failure hospitalizations and all-cause mortality in patients with HFrEF and T2DM.
- The cardiovascular protective effects of dapagliflozin were not statistically significant in the HFpEF subgroup.
- These findings highlight the differential impact of dapagliflozin based on heart failure phenotype in diabetic patients.
Background:
Cardiovascular disease threatens the health and quality of life of individuals, particularly those with type II diabetes. Recently, some studies have reported the effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors in reducing the rates of hospitalization or urgent visits, resulting in IV therapy for heart failure in patients with type 2 diabetes mellitus (T2DM).
Methods:
We did a comprehensive search in electronic databases from inception through July 2020 for randomized-controlled trials, using the keywords "sodium-glucose cotransporter-2 inhibitor", "dapagliflozin", "heart failure", "cardiovascular outcomes", "major adverse cardiovascular events", "all-cause mortality", and "cardiovascular death". Random-effects summary odds ratios (OR) were constructed using M-L heterogeneity model.
Results:
Five trials with 5,252 patients were ultimately included. The incidence of hospitalization for heart failure (HHF) (n=4, OR=0.74; 95% CI, 0.61 to 0.88; I2 = 0%) and all-cause mortality (ACM, n=4, OR=0.76; 95% CI, 0.66 to 0.94; I2 = 0%); was reduced by dapagliflozin, respectively, in all heart failure patients, without obvious heterogeneity. The incidence of cardiovascular death in dapagliflozin was lower than that in placebo without statistically significant (CVD, n=5, OR=0.84; 95% CI, 0.69 to 1.03; I2 = 0%). In HFrEF subgroup, dapagliflozin was associated with a reduced incidence of hospitalization for heart failure (n=4, OR=0.74; 95% CI, 0.60 to 0.91; I2 = 0%), cardiovascular death (n=4, OR=0.72; 95% CI, 0.58 to 0.91; I2 = 8%), and all-cause mortality (n=3, OR=0.70; 95% CI, 0.50 to 0.99; I2 = 43%) without significant heterogeneity. In contrast, in the HFpEF subgroup, there was no difference in the incidence of cardiovascular death (n=2, OR=1.45; 95% CI, 0.95 to 2.22; I2 = 0%) and all-cause mortality (n=2, OR=1.04; 95% CI, 0.76 to 1.43; I2 = 0%) between dapagliflozin and placebo.
Conclusion:
In our study, dapagliflozin performed a statistical reduction in the rate of heart failure hospitalization, cardiovascular death, and all-cause mortality in patients with HFrEF and diabetes. However, in the HFpEF subgroup, dapagliflozin did not show a significant cardiovascular protective effect.
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