Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan.
Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Medicine (Baltimore). 2022 Dec 23;101(51):e32489. doi: 10.1097/MD.0000000000032489.
Some sodium-glucose co-transporter-2 (SGLT2) inhibitors showed benefits on heart failure (HF), but different SGLT2/SGLT1 selectivity might influence the treatment effect. This study aimed to meta-analyze the treatment effects of SGLT2 inhibitors and the diversity of receptor selectivity for patients with and without HF.
Randomized controlled trials were searched in PubMed, Embase, Cochrane databases and ClinicalTrials.gov registry from inception to October 2020. The interest outcomes were analyzed with random-effects models and presented with a risk ratio (RR) and 95% confidence interval (CI). Subgroup analyses examined the treatment effects among SGLT2 inhibitors with different SGLT2/SGLT1 selectivity.
The final analyses included 10 trials and 52,607 patients. The RR of total cardiovascular (CV) death or hospitalization for HF (HHF) between SGLT2 inhibitors and placebo was 0.79 (95% CI 0.74-0.84, I2 = 31%). With SGLT2 inhibitors, HF patients had reduced mortality risks (RR 0.89, 95% CI 0.80-0.99, I2 = 0), and non-HF patients had lower risks of major adverse CV events (RR 0.92, 95% CI 0.85-0.99, I2 = 0). The risk reduction of HHF was consistent in groups of HF (RR 0.72, 95% CI 0.64-0.80, I2 = 8%) and non-HF (RR 0.74, 95% CI 0.61-0.89, I2 = 0), but the effect of the low SGLT2/SGLT1 selectivity inhibitor was insignificant in non-HF patients.
The efficacy of SGLT2 inhibitors on risk reduction of total CV death or HHF is consistent with the previous studies. The regimen is beneficial for reducing mortality in patients with HF and major adverse CV events in those without HF. Different SGLT2/SGLT1 selectivity may differ in the treatment effects in patients with and without HF.
一些钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂对心力衰竭（HF）有益，但不同的 SGLT2/SGLT1 选择性可能影响治疗效果。本研究旨在对 SGLT2 抑制剂治疗 HF 患者和非 HF 患者的效果以及受体选择性的多样性进行荟萃分析。
从建库到 2020 年 10 月，在 PubMed、Embase、Cochrane 数据库和 ClinicalTrials.gov 注册库中检索随机对照试验。采用随机效应模型分析主要结局，用风险比（RR）和 95%置信区间（CI）表示。亚组分析检查了不同 SGLT2/SGLT1 选择性的 SGLT2 抑制剂的治疗效果。
最终分析纳入 10 项试验，共 52607 例患者。SGLT2 抑制剂与安慰剂相比，全因心血管（CV）死亡或 HF 住院（HHF）的 RR 为 0.79（95%CI 0.74-0.84，I2=31%）。使用 SGLT2 抑制剂时，HF 患者的死亡率降低（RR 0.89，95%CI 0.80-0.99，I2=0），非 HF 患者的主要不良 CV 事件风险降低（RR 0.92，95%CI 0.85-0.99，I2=0）。HF 组（RR 0.72，95%CI 0.64-0.80，I2=8%）和非 HF 组（RR 0.74，95%CI 0.61-0.89，I2=0）的 HHF 风险降低情况一致，但低 SGLT2/SGLT1 选择性抑制剂对非 HF 患者的疗效不显著。
SGLT2 抑制剂降低全因 CV 死亡或 HHF 风险的疗效与既往研究一致。该方案有利于降低 HF 患者的死亡率和非 HF 患者的主要不良 CV 事件。不同的 SGLT2/SGLT1 选择性可能会影响 HF 患者和非 HF 患者的治疗效果。
