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Effects of different sodium-glucose cotransporter 2 inhibitors in heart failure with reduced or preserved ejection

Xiaohua Lan1,2, Huijing Zhu1, Yanjie Cao2

  • 1Graduate School of Hebei North University, Zhangjiakou, Hebei, China.

Frontiers in Cardiovascular Medicine
|June 7, 2024
PubMed
Abstract

Insights

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve heart failure (HF) prognosis and cardiac remodeling. Sotagliflozin showed superiority in reducing HF hospitalizations and cardiovascular death, while canagliflozin offered better safety in specific HFpEF cases.

Area of Science:

  • Cardiology
  • Pharmacology
  • Internal Medicine

Background:

  • Heart failure (HF) poses a significant global health burden.
  • Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have emerged as a promising therapeutic class for HF management.
  • Understanding the comparative efficacy and safety of different SGLT2i is crucial for optimizing patient care.

Purpose of the Study:

  • To systematically review and meta-analyze the effects of various SGLT2 inhibitors on prognosis and cardiac structural remodeling in patients with heart failure (HF).
  • To compare the efficacy and safety profiles of different SGLT2 inhibitors across the spectrum of HF, including HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF).

Main Methods:

  • A comprehensive literature search was conducted across multiple databases up to March 20, 2024.
  • Seventy-seven randomized controlled trials involving 43,561 patients with HF were included in the meta-analysis.
  • Sub-analyses were performed based on left ventricular ejection fraction (LVEF) to assess differential treatment effects.

Main Results:

  • SGLT2 inhibitors significantly improved HF outcomes, including reduced hospitalizations, improved Kansas City Cardiomyopathy Questionnaire (KCCQ) scores, and favorable changes in cardiac remodeling markers (LAVi, LVEF).
  • Sotagliflozin demonstrated superior efficacy over empagliflozin and dapagliflozin in reducing composite outcomes of HF hospitalization and cardiovascular death.
  • Dapagliflozin showed significant benefits in HFrEF patients for hospitalizations, cardiovascular death, and all-cause mortality. Canagliflozin exhibited better safety regarding urinary and reproductive infections in HFpEF patients compared to sotagliflozin.

Conclusions:

  • SGLT2 inhibitors are effective in improving the prognosis and cardiac remodeling in patients with HF.
  • Sotagliflozin and dapagliflozin show distinct advantages in specific HF populations and outcome measures.
  • The findings highlight the differential efficacy and safety of SGLT2 inhibitors, guiding personalized treatment strategies for HF management.
Keywords:
cardiac structural remodelingheart failureheart failure with preserved ejection fractionheart failure with reduced ejection fractionsodium–glucose cotransporter 2 inhibitors

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