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Comparing the Efficacy of Sodium-Glucose Cotransporter 2 Inhibitors Among Nonolder and Older Patients: A Systematic

Izuki Yamashita1, Tomohiro Fujisaki1,2, Francisco J Romeo3

  • 1Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.

Journal of Cardiovascular Pharmacology
|December 12, 2024
PubMed

Insights

Sodium-glucose cotransporter 2 (SGLT2) inhibitors effectively reduce cardiovascular events in both older and nonolder patients. These findings support the use of SGLT2 inhibitors across diverse age groups at risk for cardiovascular disease.

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Sodium-glucose cotransporter 2 (SGLT2) inhibitors demonstrate cardiovascular benefits in large trials.
  • Evidence regarding SGLT2 inhibitor efficacy in older populations is limited.
  • Older adults (≥65 years) with diabetes, chronic kidney disease, and heart failure represent a vulnerable group.

Purpose of the Study:

  • To compare the efficacy of SGLT2 inhibitors in older versus nonolder patients.
  • To evaluate the impact of SGLT2 inhibitors on cardiovascular events and disease progression in diverse age groups.

Main Methods:

  • Systematic literature search of PubMed, Cochrane Central, and Embase until February 2023.
  • Inclusion of 11 randomized controlled trials (RCTs) involving 79,370 patients.
  • Analysis of primary composite outcome (cardiovascular death, myocardial infarction, stroke) and secondary outcomes.

Main Results:

  • SGLT2 inhibitors significantly reduced the primary composite outcome in the total cohort (HR: 0.91; 95% CI, 0.84-0.99).
  • Similar risk reductions were observed in both nonolder (HR: 0.96; 95% CI, 0.88-1.05) and older (HR: 0.87; 95% CI, 0.75-1.01) populations, with no significant subgroup differences (P=0.23).
  • A composite of cardiovascular death and heart failure exacerbation was reduced in both age groups without subgroup differences (P=0.96).

Conclusions:

  • SGLT2 inhibitors demonstrate consistent efficacy in reducing cardiovascular events for both older and nonolder patients.
  • The findings support the broad application of SGLT2 inhibitors in managing cardiovascular risk across the adult age spectrum.
  • Further meta-analyses are needed for other secondary outcomes.
Keywords:
heart failureheart failure with preserved ejection fractionheart failure with reduced ejection fractionmeta-analysissodium–glucose cotransporter 2 inhibitors

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