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Inhibidores de SGLT-2 en pacientes con insuficiencia cardíaca: un metanálisis exhaustivo de cinco ensayos controlados
Muthiah Vaduganathan1, Kieran F Docherty2, Brian L Claggett1
1Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Lancet (London, England)
|August 30, 2022
Resumen
Los inhibidores del cotransportador de sodio-glucosa 2 (SGLT2) reducen significativamente la mortalidad cardiovascular y las hospitalizaciones por insuficiencia cardíaca en una amplia gama de pacientes. Estos hallazgos apoyan a los inhibidores de SGLT2 como una terapia fundamental para la insuficiencia cardíaca, independientemente de la fracción de eyección.
Área de la Ciencia:
- Cardiología
- Farmacología
- Ensayos clínicos
Sus antecedentes:
- Se recomiendan inhibidores de SGLT2 para la insuficiencia cardíaca con fracción de eyección reducida.
- Sus beneficios en pacientes con fracciones de eyección más altas están menos establecidos.
- Los grandes ensayos como DELIVER y EMPEROR-Preserved abordan esta brecha de conocimiento.
Objetivo del estudio:
- Realizar un metanálisis de los ensayos con inhibidores de SGLT2 en la insuficiencia cardíaca.
- Para evaluar su eficacia en diferentes rangos de fracción de eyección.
- Evaluar el impacto en la mortalidad cardiovascular y las hospitalizaciones por insuficiencia cardíaca.
Principales métodos:
- Metaanálisis preespecificado de los ensayos DELIVER y EMPEROR-Conservados.
- Se han incluido los ensayos DAPA-HF, EMPEROR-Reduced y SOLOIST-WHF.
- Metaanálisis de efectos fijos utilizando definiciones armonizadas de puntos finales.
Principales resultados:
- Los inhibidores de SGLT2 redujeron la muerte cardiovascular compuesta o la hospitalización por insuficiencia cardíaca (HR 0, 77).
- Se observaron reducciones consistentes en las muertes cardiovasculares (HR 0, 87) y en las hospitalizaciones por insuficiencia cardíaca (HR 0, 72).
- Los beneficios fueron consistentes entre los subgrupos de fracción de eyección y los entornos de atención.
Conclusiones:
- Los inhibidores de SGLT2 disminuyen la mortalidad cardiovascular y las hospitalizaciones por insuficiencia cardíaca en una amplia población de pacientes.
- Estos medicamentos son una terapia básica para la insuficiencia cardíaca, independientemente de la fracción de eyección.
- La evidencia apoya los inhibidores de SGLT2 como un tratamiento fundamental para todos los tipos de insuficiencia cardíaca.
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