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SGLT2 inhibitors among patients with heart failure with preserved ejection fraction: A meta-analysis of randomised

Akash Jaiswal1, Vikash Jaiswal2, Song Peng Ang3

  • 1Department of Geriatric Medicine, All India Institute of Medical Science, New Delhi, India.

Medicine
|September 29, 2023
PubMed

Insights

Sodium-glucose co-transporter 2 (SGLT2) inhibitors significantly reduce heart failure hospitalizations. While effective for reducing cardiovascular events, SGLT2 inhibitors did not show a significant impact on all-cause mortality in this analysis.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Sodium-glucose co-transporter 2 (SGLT2) inhibitors are recommended for heart failure with reduced ejection fraction (HFrEF).
  • Their efficacy in heart failure with preserved ejection fraction (HFpEF) remains debated.
  • This analysis focuses on SGLT2 inhibitor effects in HFpEF, incorporating key trials like DELIVER and EMPEROR-Preserved.

Purpose of the Study:

  • To evaluate the impact of SGLT2 inhibitors on patients with heart failure, specifically examining outcomes in HFpEF.
  • To synthesize evidence from major clinical trials investigating SGLT2 inhibitors in this population.

Main Methods:

  • A systematic literature search was conducted across PubMed, Embase, Scopus, and Cochrane libraries up to August 2022.
  • Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using a random-effects model.
  • Statistical significance was determined by a P-value < .05 and CI not crossing 1.

Main Results:

  • Six studies comprising 15,989 patients were analyzed.
  • SGLT2 inhibitors significantly reduced composite cardiovascular mortality or first heart failure hospitalization (HR, 0.80 [95% CI: 0.74-0.87]) and heart failure hospitalizations (HR, 0.74 [95% CI: 0.67-0.82]).
  • No significant difference was observed in all-cause mortality (HR, 0.97 [95% CI: 0.89-1.06]) or cardiovascular mortality (HR, 0.96 [95% CI: 0.82-1.13]).

Conclusions:

  • SGLT2 inhibitors demonstrate significant benefits in reducing heart failure hospitalizations and composite cardiovascular events in the studied population.
  • The observed benefits did not extend to a significant reduction in all-cause or cardiovascular mortality.
  • These findings contribute to understanding the role of SGLT2 inhibitors in managing heart failure patients.
Abstract

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