Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
JACC Heart Fail. 2022 Aug;10(8):559-567. doi: 10.1016/j.jchf.2022.03.006. Epub 2022 Jun 8.
Sodium-glucose co-transporter-2 (SGLT2) inhibitors improve outcomes among patients with established heart failure. Despite supportive basic science studies, there are no data on the value of SGLT2 inhibitors among patients treated with anthracyclines.
This study sought to test the cardiac efficacy and overall safety of SGLT2 inhibitors in patients treated with anthracyclines.
This study identified 3,033 patients with diabetes mellitus (DM) and cancer who were treated with anthracyclines. Cases were patients with cancer and DM who were on SGLT2 inhibitor therapy during anthracycline treatment (n = 32). Control participants (n = 96) were patients with cancer and DM who were also treated with anthracyclines, but were not on an SGLT2 inhibitor. The primary cardiac outcome was a composite of cardiac events (heart failure incidence, heart failure admissions, new cardiomyopathy [>10% decline in ejection fraction to <53%], and clinically significant arrhythmias). The primary safety outcome was overall mortality.
Age, sex, ethnicity, cancer type, cancer stage, and other cardiac risk factors were similar between groups. There were 20 cardiac events over a median follow-up period of 1.5 years. The cardiac event incidence was lower among case patients in comparison to control participants (3% vs 20%; P = 0.025). Case patients also experienced lower overall mortality when compared with control participants (9% vs 43%; P < 0.001) and a lower composite of sepsis and neutropenic fever (16% vs 40%; P = 0.013).
SGLT2 inhibitors were associated with lower rate of cardiac events among patients with cancer and DM who were treated with anthracyclines. Additionally, SGLT2 inhibitors appeared to be safe. These data support the conducting of a randomized clinical trial testing SGLT2 inhibitors in patients at high cardiac risk treated with anthracyclines.
钠-葡萄糖协同转运蛋白 2（SGLT2）抑制剂可改善已患有心力衰竭的患者的预后。尽管有支持性的基础科学研究，但在接受蒽环类药物治疗的患者中，尚无关于 SGLT2 抑制剂价值的数据。
本研究旨在测试 SGLT2 抑制剂在接受蒽环类药物治疗的患者中的心脏疗效和整体安全性。
本研究确定了 3033 名患有糖尿病（DM）和癌症并接受蒽环类药物治疗的患者。病例组为在蒽环类药物治疗期间接受 SGLT2 抑制剂治疗的癌症和 DM 患者（n=32）。对照组（n=96）为癌症和 DM 患者，也接受了蒽环类药物治疗，但未接受 SGLT2 抑制剂治疗。主要心脏结局为心脏事件的综合指标（心力衰竭发生率、心力衰竭住院、新发心肌病[射血分数下降>10%至<53%]和临床显著心律失常）。主要安全性结局为全因死亡率。
两组患者的年龄、性别、种族、癌症类型、癌症分期和其他心脏危险因素相似。中位随访 1.5 年期间共发生 20 例心脏事件。与对照组相比，病例组的心脏事件发生率较低（3%比 20%；P=0.025）。与对照组相比，病例组的总死亡率也较低（9%比 43%；P<0.001），且复合感染和中性粒细胞减少性发热的发生率也较低（16%比 40%；P=0.013）。
在接受蒽环类药物治疗的癌症和 DM 患者中，SGLT2 抑制剂与较低的心脏事件发生率相关。此外，SGLT2 抑制剂似乎是安全的。这些数据支持在接受蒽环类药物治疗且心脏风险较高的患者中开展 SGLT2 抑制剂的随机临床试验。
