Effect of SGLT2 Inhibitors on Cardiovascular Outcomes Across Various Patient Populations

Jun 21, 2023Journal of the American College of Cardiology

How SGLT2 Inhibitors May Affect Heart Health in Different Patient Groups

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Abstract

SGLT2 inhibitors reduced the risk of first heart failure hospitalization or cardiovascular death by 24% in heart failure patients.

The analysis included 13 trials with a total of 90,413 participants.
SGLT2 inhibitors lowered the risk of first heart failure hospitalization or cardiovascular death by 24% in heart failure patients.
A similar reduction of 23% was observed in patients with type 2 diabetes mellitus and chronic kidney disease.
The reduction in cardiovascular death was 16% in heart failure patients, 15% in those with type 2 diabetes, and 12% in chronic kidney disease patients.
The benefits of SGLT2 inhibitors were consistent across various subgroups, including those with different types of heart failure and combinations of comorbidities.

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BACKGROUND: The effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors on heart failure (HF) outcomes and cardiovascular (CV) death in patients with varying combinations of type 2 diabetes mellitus (T2DM), HF, and chronic kidney disease (CKD) are uncertain.

OBJECTIVES: The authors conducted a meta-analysis assessing the effects of SGLT2 inhibitors on HF outcomes and CV death across different patient populations.

METHODS: Online databases were queried up to November 2022 for primary and secondary analyses of trials of SGLT2 inhibitors in patients with HF, T2DM, or CKD. Outcomes of interest were composite of first heart failure hospitalization (HFH) or CV death (first HFH/CV death), first HFH, and CV death. Data were pooled by means of a random-effects model to derive HRs and 95% CIs.

RESULTS: Thirteen trials (n = 90,413) were included. Compared with placebo, SGLT2 inhibitors reduced the risk of first HFH/CV death by 24% in HF (HR: 0.76; 95% CI: 0.72-0.81), 23% in T2DM (HR: 0.77; 95% CI: 0.73-0.81), and 23% in CKD (HR: 0.77; 95% CI: 0.72-0.82). The benefit was consistent in HF with reduced or preserved ejection fraction, HF with or without T2DM, and HF with or without CKD. The benefit was also consistent in T2DM with or without CKD, T2DM without HF, CKD without HF, and in patients with all 3 comorbidities. SGLT2 inhibitors significantly reduced CV death by 16% in HF, 15% in T2DM, and 12% in CKD.

CONCLUSIONS: SGLT2 inhibitors reduce HF events and CV death in cohorts of HF, T2DM and CKD, and these effects appear consistent in patients with varying combinations of these diseases.

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Effect of SGLT2 Inhibitors on Cardiovascular Outcomes Across Various Patient Populations

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