SGLT2 Inhibitors in Older Adults With Cardiovascular Disease: A Systematic Review and Meta-Analysis

Area of Science:

• Cardiology
• Pharmacology
• Geriatrics

Background:

• Sodium-glucose cotransporter-2 (SGLT2) inhibitors are established treatments for type 2 diabetes mellitus (T2DM).
• These agents have demonstrated significant cardiorenal benefits beyond glycemic control.
• Evidence synthesis for older adults with cardiovascular disease (CVD) is limited.

Purpose of the Study:

• To systematically review and meta-analyze the efficacy of SGLT2 inhibitors in older adults (≥65 years) with CVD.
• To evaluate the impact on composite cardiovascular outcomes, all-cause mortality, cardiovascular death, and hospitalization for heart failure.
• To assess safety and efficacy across various subgroups.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) from January 2015 to January 2025.
• Included studies focused on older adults (≥65 years) with pre-existing cardiovascular disease.
• Primary outcome: composite of hospitalization for heart failure (HHF), urgent heart failure (HF) visits, and cardiovascular death (CVD).

Main Results:

• SGLT2 inhibitors significantly reduced the composite outcome (HR: 0.75), all-cause mortality (HR: 0.80), CVD (HR: 0.78), and HHF (HR: 0.73).
• Benefits were consistent across subgroups including heart failure, T2DM, and older age strata (≥75 years).
• Increased risk of genital infections was noted, but other serious adverse events were reduced.

Conclusions:

• SGLT2 inhibitors demonstrate significant efficacy in reducing major adverse cardiovascular events in older adults with CVD.
• Findings support the use of SGLT2 inhibitors in this population, particularly for those with HF or T2DM.
• Careful monitoring for adverse events, such as genital infections, is recommended.