Department of Cardiology, Shandong Provincial Hospital, Shandong First Medical University, Shandong Academy of Medical Sciences, Shandong 250021, China.
Department of Endocrinology, Yantaishan Hospital, Shandong 264003, China.
Int J Cardiol. 2021 Jun 1;332:119-126. doi: 10.1016/j.ijcard.2021.03.077. Epub 2021 Apr 8.
Sodium-glucose co-transporter 2 inhibitor (SGLT2i), initially introduced for the treatment of diabetes mellitus (DM), demonstrates cardiovascular and renal benefits in patients with heart failure (HF). We aimed to conduct a meta-analysis of its effects on cardiovascular, renal, and major safety outcomes in HF.
PubMed, Embase, Cochrane Library, and Web of Science were searched using the terms of "SGLT2i and HF" or "SGLT2i *". Seven randomized, placebo-controlled trials comprising 14,113 HF patients (mean age, 66.0 years; female, 27.6%; DM, 58.9%) were included. SGLT2i treatment was associated with lower incidences (compared with placebo) of the composite outcomes of cardiovascular death or hospitalization for HF (HHF) (ratio risk [RR] 0.773; 95% confidence interval [CI], 0.719-0.831; p < 0.001; I = 8.1%), cardiovascular death (RR 0.872; 95% CI, 0.788-0.964; p = 0.008; I = 0.0%), HHF (RR 0.722; 95% CI, 0.657-0.793; p < 0.001; I = 15.4%) and serious decrease in renal function (RR 0.673; 95% CI, 0.549-0.825; p < 0.001; I = 17.7%). SGLT2i treatment was associated with a lower incidence of serious adverse events (SAEs) (RR 0.867; 95% CI, 0.808-0.930; p < 0.001; I = 60.1%), but a higher incidence of volume depletion (RR 1.177; 95% CI, 1.040-1.333; p = 0.010; I = 0.0%). Analysis on patients without DM showed consistent results, except for cardiovascular death.
SGLT2i treatment contributed to better cardiovascular and renal outcomes in patients with HF, regardless of the presence or absence of DM. SGLT2i also resulted in a lower incidence of SAEs, although a higher incidence of volume depletion was observed.
钠-葡萄糖协同转运蛋白 2 抑制剂（SGLT2i）最初被引入用于治疗糖尿病（DM），但其在心力衰竭（HF）患者中具有心血管和肾脏获益。我们旨在对其在 HF 中的心血管、肾脏和主要安全性结局的影响进行荟萃分析。
使用“SGLT2i 和 HF”或“SGLT2i*”术语，在 PubMed、Embase、Cochrane 图书馆和 Web of Science 中进行检索。纳入了 7 项随机、安慰剂对照试验，共纳入 14113 例 HF 患者（平均年龄 66.0 岁；女性 27.6%；DM 58.9%）。与安慰剂相比，SGLT2i 治疗降低了心血管死亡或因 HF 住院的复合结局（心血管死亡或 HF 住院复合终点）发生率（比值比 [RR] 0.773；95%置信区间 [CI]，0.719-0.831；p < 0.001；I = 8.1%）、心血管死亡（RR 0.872；95% CI，0.788-0.964；p = 0.008；I = 0.0%）、HF 住院（RR 0.722；95% CI，0.657-0.793；p < 0.001；I = 15.4%）和严重肾功能下降（RR 0.673；95% CI，0.549-0.825；p < 0.001；I = 17.7%）。SGLT2i 治疗与严重不良事件（RR 0.867；95% CI，0.808-0.930；p < 0.001；I = 60.1%）发生率降低相关，但与容量不足（RR 1.177；95% CI，1.040-1.333；p = 0.010；I = 0.0%）发生率升高相关。在不伴 DM 的患者中进行的分析得到了一致的结果，除了心血管死亡。
SGLT2i 治疗可改善 HF 患者的心血管和肾脏结局，无论是否存在 DM。尽管观察到容量不足发生率较高，但 SGLT2i 也可降低严重不良事件的发生率。
