Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK.
Diabetes Obes Metab. 2023 Feb;25(2):501-515. doi: 10.1111/dom.14893. Epub 2022 Nov 2.
To determine the absolute risk reduction (ARR) of heart failure events in people treated with sodium-glucose co-transporter-2 (SGLT2) inhibitors.
We searched PubMed, EMBASE, CINAHL and ISI Web of Science for observational studies published to 9 May 2022 that explored the association between SGLT2 inhibitors and any indication for heart failure (including new diagnosis or hospitalization for heart failure) in type 2 diabetes. Identified studies were independently screened by two reviewers and assessed for bias using the Newcastle-Ottawa scale. Eligible studies with comparable outcome data were pooled for meta-analysis using random-effects models, reporting hazard ratios (HRs) with 95% confidence intervals (CIs). The ARR per 100 person-years was determined overall, and in subgroups with and without baseline cardiovascular disease (CVD).
From 43 eligible studies, with a total of 4 818 242 participants from 17 countries, 21 were included for meta-analysis. SGLT2 inhibitors were associated with a reduced risk of hospitalization for heart failure (HR 0.65, 95% CI 0.59-0.72) overall and both in those with CVD (HR 0.78, 95% CI 0.68-0.89) and without CVD (HR 0.53, 95% CI 0.39-0.71). Risk reduction for hospitalization for heart failure in people with a history of CVD (ARR 1.17, 95% CI 0.78-1.55) was significantly greater than for those without CVD (ARR 0.39, 95% CI 0.32-0.47). The number-needed-to-treat to prevent one event of hospitalization for heart failure was 86 (95% CI 65-128) person-years of treatment for the CVD group and 256 (95% CI 215-316) person-years for those without CVD.
Real-world SGLT2 inhibitor use supports randomized trial data for the size effect of reduced hospitalization for heart failure in type 2 diabetes, although with a much lower ARR in people without CVD.
确定钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂治疗人群中心力衰竭事件的绝对风险降低（ARR）。
我们检索了 PubMed、EMBASE、CINAHL 和 ISI Web of Science，以查找截至 2022 年 5 月 9 日发表的观察性研究，这些研究探讨了 SGLT2 抑制剂与 2 型糖尿病中任何心力衰竭指征（包括心力衰竭的新诊断或住院治疗）之间的关联。两名评审员独立筛选确定的研究，并使用纽卡斯尔-渥太华量表评估偏倚。对具有可比结局数据的合格研究进行荟萃分析，采用随机效应模型，报告风险比（HR）及其 95%置信区间（CI）。总体上以及在基线时无或有心血管疾病（CVD）的亚组中，确定每 100 人年的 ARR。
从来自 17 个国家的 43 项合格研究中，共有 4818242 名参与者，其中 21 项研究纳入荟萃分析。总体上以及在有 CVD（HR 0.78，95%CI 0.68-0.89）和无 CVD（HR 0.53，95%CI 0.39-0.71）的患者中，SGLT2 抑制剂与心力衰竭住院风险降低相关。有 CVD 病史的患者因心力衰竭住院的风险降低（ARR 1.17，95%CI 0.78-1.55）显著大于无 CVD 患者（ARR 0.39，95%CI 0.32-0.47）。预防心力衰竭住院的事件需要治疗的人数（NNT）在有 CVD 组为 86（95%CI 65-128）人年，在无 CVD 组为 256（95%CI 215-316）人年。
真实世界 SGLT2 抑制剂的应用支持随机试验数据表明，2 型糖尿病患者因心力衰竭住院的风险降低幅度较大，尽管无 CVD 患者的 ARR 要低得多。
