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Sodium-Glucose Cotransporter 2 Inhibitors in Underweight Patients with Heart Failure: A Case Series
Masaki Nakagaito1, Teruhiko Imamura1, Toshihide Izumida1
1Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan.
Insights
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) did not reduce cardiovascular events in underweight heart failure patients. This therapy was linked to increased overall hospitalizations and decreased BMI in this population.
Area of Science:
- Cardiology
- Pharmacology
- Metabolic Disorders
Background:
- Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are established treatments for heart failure (HF), improving mortality and morbidity.
- The effectiveness and safety of SGLT2i in underweight HF patients (BMI < 18.5 kg/m²) are not well understood.
- Underweight status in HF patients presents unique challenges for treatment optimization.
Purpose of the Study:
- To investigate the efficacy of SGLT2i in reducing cardiovascular events in underweight patients with heart failure.
- To assess the safety profile of SGLT2i, including hospitalization rates and body mass index (BMI) changes, in this patient group.
- To evaluate the impact of SGLT2i on overall hospitalization rates and BMI in underweight heart failure patients.
Main Methods:
- A single-center, prospective observational study.
- Enrolled 131 underweight HF patients (BMI > 18.5 kg/m²) between December 2020 and October 2023.
- Compared outcomes between 28 patients who initiated SGLT2i and 103 who did not, with a median follow-up of 20.4 months.
Main Results:
- The primary outcome (HF hospitalization or cardiovascular death) occurred in 21.4% of patients in both the SGLT2i and non-SGLT2i groups (p=0.758).
- Patients receiving SGLT2i experienced significantly higher all-cause hospitalizations (82.1% vs. 63.1%, p=0.009).
- SGLT2i initiation was associated with a significant decrease in BMI at discharge, 1 month, and 3 months post-discharge compared to the control group.
Conclusions:
- SGLT2i therapy may not confer cardiovascular benefits in underweight heart failure patients.
- SGLT2i use in this population is associated with an increased risk of overall hospitalizations.
- SGLT2i treatment leads to a reduction in body mass index among underweight heart failure patients.
Abstract:
Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduce mortality and morbidity in patients with heart failure (HF). However, their efficacy and safety in underweight patients remain uncertain. This study aimed to evaluate the efficacy and safety of SGLT2i in underweight patients with HF. Methods: This study was a single-center, prospective observational study designed to assess the efficacy of SGLT2i therapy in underweight patients with HF. The primary outcome was a composite of unplanned hospitalization for HF or death from cardiovascular causes. A key secondary outcome was hospitalization from any cause. Results: This study enrolled 131 consecutive patients with a body mass index (BMI) > 18.5 kg/m2 hospitalized for HF between December 2020 and October 2023. The median age of the study population was 81 (73-87) years, and 60% were female. Baseline BMI was 17.2 (16.0-17.9) kg/m2. Of these, 28 patients initiated SGLT2i during index hospitalization, while the remaining 103 did not receive SGLT2i. Over a median of 20.4 months of follow-up, the primary outcome occurred in 6 of 28 patients (21.4%) with SGLT2i and 22 of 103 patients (21.4%) without SGLT2i (p = 0.758). All-cause hospitalizations occurred in 23 of 28 patients (82.1%) with SGLT2i and 65 of 103 patients (63.1%) without SGLT2i (p = 0.009). Patients receiving SGLT2i showed a significant decrease in BMI at discharge, 1 month after discharge, and 3 months after discharge compared with those without SGLT2i (p < 0.05 for each time point). Conclusions: SGLT2i in underweight patients with HF may not reduce cardiovascular event risk and may be associated with a higher rate of overall hospitalizations.
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