Cardoso Rhanderson, Graffunder Fabrissio P, Ternes Caique M P, Fernandes Amanda, Rocha Ana V, Fernandes Gilson, Bhatt Deepak L
Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
Division of Medicine, Federal University of Santa Catarina, Florianopolis, Brazil.
EClinicalMedicine. 2021 Jun 5;36:100933. doi: 10.1016/j.eclinm.2021.100933. eCollection 2021 Jun.
Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the composite of heart failure (HF) hospitalizations or cardiovascular mortality among patients with HF. However, the efficacy of SGLT2 inhibitors in secondary endpoints of randomized trials and in subgroups of HF patients is not well known.
We performed a systematic review and meta-analysis of placebo-controlled, randomized trials of SGLT2 inhibitors in patients with HF. PubMed, Embase, and Cochrane databases were searched for trials published up to January 21, 2021. Data were extracted from published reports and quality assessment was performed per Cochrane recommendations. Hazard ratios (HRs) with 95% CI were pooled across trials. The primary endpoints of interest were all-cause and cardiovascular mortality.
Out of 3969 database results, 15 randomized trials and 20,241 patients were included; 10,594 (52·3%) received SGLT2 inhibitors. All-cause mortality (HR 0·86; 95% CI 0·79-0·94; = 0·0007; I=0%) and cardiovascular mortality (HR 0·86; 95% CI 0·78-0·96; = 0·006; I=0%) were significantly lower in patients treated with SGLT2 inhibitors compared with placebo. The composite of cardiovascular mortality, HF hospitalizations, or urgent visits for HF was significantly reduced with SGLT2 inhibitors in all the following subgroups: male, female, age < 65, age ≥ 65, race - Black and White, estimated glomerular filtration rate (eGFR) <60, eGFR ≥60, New York Heart Association (NYHA) class II, NYHA ≥III, and HF with preserved ejection fraction.
In patients with HF, SGLT2 inhibitors significantly reduce all-cause and cardiovascular mortality compared with placebo. In addition, the composite of cardiovascular mortality or HF hospitalizations/urgent visits is reduced with SGLT2 inhibitors across subgroups of sex, age, race, eGFR, HF functional class, and ejection fraction.
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂可降低心力衰竭（HF）患者的心力衰竭住院或心血管死亡复合终点事件的发生风险。然而，SGLT2抑制剂在随机试验次要终点以及HF患者亚组中的疗效尚不清楚。
我们对SGLT2抑制剂用于HF患者的安慰剂对照随机试验进行了系统评价和荟萃分析。检索了PubMed、Embase和Cochrane数据库中截至2021年1月21日发表的试验。数据从已发表的报告中提取，并按照Cochrane推荐进行质量评估。对各试验的风险比（HR）及95%置信区间（CI）进行汇总。感兴趣的主要终点为全因死亡率和心血管死亡率。
在3969条数据库结果中，纳入了15项随机试验和20241例患者；其中10594例（52.3%）接受了SGLT2抑制剂治疗。与安慰剂相比，接受SGLT2抑制剂治疗的患者全因死亡率（HR 0.86；95%CI 0.79-0.94；P=0.0007；I²=0%）和心血管死亡率（HR 0.86；95%CI 0.78-0.96；P=0.006；I²=0%）显著降低。在以下所有亚组中，SGLT2抑制剂均显著降低了心血管死亡率、HF住院或HF紧急就诊的复合终点事件发生风险：男性、女性、年龄<65岁、年龄≥65岁、种族-黑人和白人、估计肾小球滤过率（eGFR）<60、eGFR≥60、纽约心脏协会（NYHA）II级、NYHA≥III级以及射血分数保留的HF患者。
在HF患者中，与安慰剂相比，SGLT2抑制剂显著降低全因死亡率和心血管死亡率。此外，在性别、年龄、种族、eGFR、HF功能分级和射血分数等亚组中，SGLT2抑制剂均降低了心血管死亡率或HF住院/紧急就诊的复合终点事件发生风险。
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