Zhao Li-Min, Zhan Ze-Lin, Qiu Mei
Department of Endocrinology, Shenzhen Longhua District Central Hospital, Shenzhen, China.
Class 3, Clinical medicine, Grade 2019, The Second Clinical Medical College, Southern Medical University, Guangzhou, China.
Ther Adv Endocrinol Metab. 2021 Sep 23;12:20420188211044945. doi: 10.1177/20420188211044945. eCollection 2021.
The effects of sodium-glucose transporter 2 (SGLT2) inhibitors on cardiovascular death (CV death) and all-cause death (AC death) in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) are currently under intensive investigation. We intended to conduct an updated meta-analysis including the SCORED trial to evaluate the effects of SGLT2 inhibitors on death and cardiorenal events in this vulnerable population.
Cardiorenal outcome trials of SGLT2 inhibitors were included. Primary outcomes were CV death and AC death, while secondary outcomes were hospitalization for heart failure (HHF), myocardial infarction (MI), CKD progression, cardiovascular death or hospitalization for heart failure (CV death or HHF), major adverse cardiovascular events (MACE), and stroke. Meta-analysis was conducted for each outcome.
Eight trials were included for meta-analysis. Compared with placebo, SGLT2 inhibitors significantly lowered the risk of CV death (HR = 0.86, 95% CI = 0.75-0.98), AC death (HR = 0.87, 95% CI = 0.79-0.96), HHF (HR = 0.64, 95% CI = 0.56-0.74), MI (HR = 0.76, 95% CI = 0.65-0.89), CKD progression (HR = 0.62, 95% CI = 0.54-0.72), and CV death or HHF (HR = 0.73, 95% CI = 0.67-0.80). No heterogeneity existed in the above meta-analyses (all I values = 0%), whereas moderate heterogeneity existed in the meta-analyses for MACE and stroke (I = 31.6% and 44.5%, respectively).
Our findings suggest that SGLT2 inhibitors versus placebo significantly lower death, heart failure, renal failure, and MI events in patients with T2D and CKD. Head-to-head trials are needed to examine the possible differences in the effects of various gliflozins on MACE and stroke.
目前正在深入研究钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂对2型糖尿病（T2D）合并慢性肾脏病（CKD）患者心血管死亡（CV死亡）和全因死亡（AC死亡）的影响。我们旨在进行一项纳入SCORED试验的更新荟萃分析，以评估SGLT2抑制剂对这一脆弱人群死亡和心肾事件的影响。
纳入SGLT2抑制剂的心肾结局试验。主要结局为CV死亡和AC死亡，次要结局为因心力衰竭住院（HHF）、心肌梗死（MI）、CKD进展、心血管死亡或因心力衰竭住院（CV死亡或HHF）、主要不良心血管事件（MACE）和卒中。对每个结局进行荟萃分析。
八项试验纳入荟萃分析。与安慰剂相比，SGLT2抑制剂显著降低了CV死亡风险（HR = 0.86，95%CI = 0.75 - 0.98）、AC死亡风险（HR = 0.87，95%CI = 0.79 - 0.96）、HHF风险（HR = 0.64，95%CI = 0.56 - 0.74）、MI风险（HR = 0.76，95%CI = 0.65 - 0.89）、CKD进展风险（HR = 0.62，95%CI = 0.54 - 0.72）以及CV死亡或HHF风险（HR = 0.73，95%CI = 0.67 - 0.80）。上述荟萃分析中不存在异质性（所有I值 = 0%），而MACE和卒中的荟萃分析中存在中度异质性（I分别为31.6%和44.5%）。
我们的研究结果表明，与安慰剂相比，SGLT2抑制剂显著降低了TID和CKD患者的死亡、心力衰竭、肾衰竭和MI事件风险。需要进行直接比较试验，以研究各种格列净类药物对MACE和卒中影响的可能差异。
